Minimally invasive coronary bypass grafting for treating multivessel coronary disease: A single-center prospective pilot study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Multivessel coronary artery disease (n=403). Intervention: Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) vs. Sternotomy off-pump coronary artery bypass grafting (OPCAB). Primary outcome: 30-day Physical Component Summary (PCS-HK) subscale score of the 36-Item Short-Form Health Survey (SF-36) (p=<0.001).

Q: What does this research mean for the field?

In patients with multivessel coronary artery disease, minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) significantly improves early physical function at 7 and 30 days postoperatively compared with sternotomy off-pump coronary artery bypass, while offering comparable 12-month angina relief. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tong Ding; Yichen Gong; Yuanhao Fu; Zhongqi Cui; Song Wu; Wei Yang; Hang Yang; Hong Zhao; Haibo Feng; Huiping Zheng; Rui Guo; Hui Han; Yunpeng Ling

doi:10.1016/j.xjon.2025.03.030

May 4, 2025JTCVS OpenOpen Access

Minimally invasive coronary bypass grafting for treating multivessel coronary disease: A single-center prospective pilot study

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Key result

MICS-CABG improved 30-day SF-36 Physical Component Summary scores compared with sternotomy OPCAB in patients with multivessel coronary disease.

Figures

Graphical abstract published by JTCVS Open — Graphical abstract · Published by JTCVS Open · CC BY-NC-ND

Why the study?

The study sought to explore characteristics and outcomes of patients undergoing MICS-CABG versus off-pump CABG for MICS-CABG-eligible multivessel disease to inform the design of a confirmatory comparative effectiveness trial.

Does minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) improve early postoperative health-related quality of life (SF-36 PCS and MCS scores) compared with sternotomy off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease?

Key Points

To evaluate the characteristics, clinical outcomes, and health-related quality of life in patients undergoing minimally invasive cardiac surgery-coronary artery bypass grafting versus off-pump coronary artery bypass for multivessel disease.
Prospective interventional pilot study conducted over 30 months enrolling 245 MICS-CABG and 158 off-pump coronary artery bypass (OPCAB) participants (NCT04267835).
Propensity score matching created 120 matched pairs to compare procedural variables and postoperative clinical outcomes.
Health-related quality of life was measured using the 36-Item Short-Form Health Survey (SF-36) physical and mental component summaries and the Seattle Angina Questionnaire across 5 domains over 12 months.
Physical Component Summary scores were significantly higher in the MICS-CABG group than the OPCAB group at 7 days (Hong Kong: P = .001; United States: P = .002) and 30 days (Hong Kong: P < .001; United States: P = .002).
Mental Component Summary scores and all 5 Seattle Angina Questionnaire domain scores did not differ significantly between the 2 groups throughout follow-up.
In matched analyses, MICS-CABG was associated with less dialysis (0 vs 5.8%; P = .01), fewer red blood cell transfusions (7.5% vs 16.7%; P = .03), and shorter hospital stays (7 days vs 8 days; P = .002), with no significant difference in graft patency (97.1 vs 96.4; P = .62).

Study Design

Type

Cohort (n=403)

Blinding

Open-label

Multicenter

No

Structured PICO

Does minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) improve early postoperative health-related quality of life (SF-36 PCS and MCS scores) compared with sternotomy off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease?

P

Population

403 adults with multivessel coronary artery disease eligible for MICS-CABG (mean age ~65 years, 23.8% female) at a single center in China, followed for 12 months.

E

Exposure

Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) performed off-pump via a left minithoracotomy (4-6 cm, left fourth- or fifth-intercostal spaces, between the midclavicular and anterior axillary lines) under direct vision.

C

Comparator

Off-pump coronary artery bypass grafting (OPCAB) performed via median sternotomy.

O

Outcome

General health status assessed by the Physical Component Summary (PCS) and Mental Component Summary (MCS) subscale scores of the 36-Item Short-Form Health Survey (SF-36; range 0 to 100, with higher scores indicating better health status), evaluated at admission, 7 days, and 1, 3, 6, and 12 months after surgery.patient reported

Main Result

Absolute Event Rate: 38.31% vs 34.17%

p-value: p=<0.001

In patients with multivessel coronary artery disease, MICS-CABG provides faster early physical recovery at 7 and 30 days post-surgery with comparable pre-discharge graft patency and 1-year angina relief compared to conventional sternotomy OPCAB.

Limitations

Observational and nonrandomized study design
Single-center study limiting generalizability
Potential for unmeasured confounders despite propensity score matching
PCS scores in both groups did not return to preoperative levels at 30 days
Observational and nonrandomized nature
Single-center design
Unmeasured confounders limit the generalizability of findings despite propensity score matching

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Implication

Supports faster early recovery with MICS-CABG in selected multivessel CAD patients; leaves open whether these observational benefits persist in randomized trials with long-term clinical outcomes.

Abstract

Objectives: The study sought to explore the characteristics and outcomes of patients undergoing clinically indicated minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) and off-pump coronary artery bypass for MICS-CABG eligible multivessel disease, to inform the design of a confirmatory comparative effectiveness trial. Methods: Over 30 months, 245 MICS-CABG and 158 off-pump coronary artery bypass participants were enrolled. Health-related quality-of-life was assessed using the 36-Item Short-Form Health Survey and Seattle Angina Questionnaire. The primary end point was the score on the physical component summary and mental component summary subscale of the 36-Item Short-Form Health Survey (on which scores range from 0 to 100, with higher scores indicating better health status). Results: < .001, respectively). The mental component summary subscale of the 36-Item Short-Form Health Survey in either the United States or Hong Kong and all 5 domains of Seattle Angina Questionnaire score were similar between the 2 groups throughout the follow-up period. Conclusions: MICS-CABG, an emerging modality for treating multivessel coronary disease, yields an improved 7- and 30-day physical function than off-pump coronary artery bypass. Moreover, both strategies resulted in similar significant relief from angina over 12 months. A randomized controlled trial is warranted to compare the efficacy of these 2 revascularization strategies. (Prospective Cohort Study on Minimal Invasive Coronary Surgery: NCT04267835).

Discussion

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Cite This Study

Ding et al. (2025) conducted a cohort in Multivessel coronary artery disease (n=403). Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) vs. Sternotomy off-pump coronary artery bypass grafting (OPCAB) was evaluated on 30-day Physical Component Summary (PCS-HK) subscale score of the 36-Item Short-Form Health Survey (SF-36) (p=<0.001). MICS-CABG improved 30-day SF-36 Physical Component Summary scores compared with sternotomy OPCAB in patients with multivessel coronary disease.

synapsesocial.com/papers/6a857237916c5a6accada681 https://doi.org/10.1016/j.xjon.2025.03.030

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Minimally invasive coronary bypass grafting for treating multivessel coronary disease: A single-center prospective pilot study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Minimally invasive coronary bypass grafting for treating multivessel coronary disease: A single-center prospective pilot study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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