Left Ventricular Remodeling After Total Coronary Revascularization via Anterior Thoracotomy Versus Conventional Coronary Artery Bypass Grafting

Total coronary revascularization via anterior thoracotomy (TCRAT) enables complete anatomical revascularization without sternotomy; however, data on its impact on left ventricular function remain limited. This study compared left ventricular functional outcomes between TCRAT and median sternotomy coronary artery bypass grafting (MS-CABG) in 554 patients undergoing elective isolated CABG at four centers (January 2020–January 2025) with preoperative and ≥3-month follow-up echocardiography. Patients were grouped as TCRAT (n = 241) or MS-CABG (n = 313). Stabilized inverse probability of treatment weighting was applied to reduce selection bias, achieving adequate covariate balance (all standardized mean differences < 0.10). The primary endpoint was follow-up left ventricular ejection fraction, assessed using IPTW-weighted analysis of covariance adjusted for preoperative values. No significant difference was observed between groups (β = 0.13; 95% CI, −0.63 to 0.90; p = 0.734). Adjusted left ventricular end-diastolic diameter was modestly higher in the MS-CABG group (β = 0.57 mm; 95% CI, 0.17–0.98; p = 0.006), while end-systolic diameter was similar. TCRAT was associated with longer operative times but shorter intensive care unit and hospital stays, along with lower transfusion requirements. These findings suggest that there was no statistically significant difference in follow-up systolic function between the surgical approaches. Although a modest difference in LVEDD was identified, its clinical significance remains uncertain.