Endoscopic-assisted, minimally invasive versus sternotomy total arterial multivessel bypass grafting.

Objectives: This single-centre study compared the perioperative outcomes after total arterial multivessel revascularization through endoscopic-assisted, minimally invasive surgery compared to a conventional sternotomy approach.

Methods: In this retrospective, propensity score-matched (PSM) cohort study, a total of 740 patients were analysed [endoscopic coronary artery bypass grafting (Endo-CAB), N = 92; Sternotomy, N = 648]. After PSM (1:2 ratio), 73 Endo-CAB and 137 sternotomy patients were compared with an equal number of distal anastomoses (Endo-CAB 2.3 versus Sternotomy 2.4 anastomoses per patient, P = 0.082). We used 'textbook outcome' as a patient-orientated outcome measure, defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischaemia, cardiac tamponade, cerebrovascular events, wound infection, new onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (>7 days).

Results: Patients undergoing Endo-CAB had significantly more often a textbook outcome compared to the sternotomy group (78.1% vs 59.1%, P = 0.009). Endo-CAB patients had shorter hospital stay (4.0 vs 6.0 days, P < 0.001), less postoperative blood loss (360 vs 490 ml, P < 0.001) and a significant reduction of new onset postoperative atrial fibrillation (5.5% vs 17.5%, P = 0.015). Other postoperative outcomes were comparable for both groups.

Conclusions: Total arterial Endo-CAB demonstrates excellent postoperative outcomes compared to a sternotomy approach for multivessel coronary artery disease. These findings provide a strong basis for further expanding the multivessel Endo-CAB programme.