Enhanced Recovery and Reduced Complications with Minimally Invasive Coronary Artery Bypass Grafting Compared to Open Sternotomy.

Abstract

Background: Minimally invasive coronary artery bypass grafting (MICS CABG) via left anterior thoracotomy has emerged as a less invasive alternative to conventional open sternotomy (OPEN CABG), offering potential benefits in perioperative outcomes and complication rates.

Objective: The aim of this study was to compare procedural characteristics, ventilation duration, drainage volumes, and postoperative complications between MICS CABG and OPEN CABG in a single-center cohort in Bosnia and Herzegovina.

Methods: This retrospective cross-sectional study included 262 patients who underwent surgical revascularization between January 2019 and June 2023.

Results: MICS CABG was associated with a shorter median procedure time (2.5 vs. 3.5 hours, p<0.001) and reduced mechanical ventilation duration (11.0 vs. 14.0 hours, p<0.001). Although ICU stay was similar (3.0 days, p=0.001), total hospitalization was shorter for MICS CABG (6.0 vs. 7.0 days, p<0.001). Postoperative drainage was significantly lower at all measured time points (p<0.05), and transfusion requirements were reduced for red blood cells (0 vs. 2 units, p<0.001), fresh frozen plasma (0 vs. 2.5 units, p<0.001), and platelets (p=0.035). Use of inotropic agents was less frequent in MICS CABG, both at low (50.4% vs. 62.8%, p=0.043) and medium doses (4.0% vs. 16.0%, p=0.001). Wound infections were numerically lower in the MICS group (p=0.437).

Conclusions: Compared to open sternotomy, MICS CABG demonstrated significant advantages in operative time, ventilation duration, blood loss, and complication rates, supporting its role as a safe and effective alternative for coronary revascularization.