title: Results of the Minimally Invasive Coronary Artery Bypass Grafting Angiographic Patency Study.
abstract: OBJECTIVE
  Minimally invasive coronary artery bypass grafting is safe and widely applicable, and may be associated with fewer transfusions and infections, and better recovery than standard coronary artery bypass grafting. However, graft patency rates remain unknown. The Minimally Invasive Coronary Artery Bypass Grafting Patency Study prospectively evaluated angiographic graft patency 6 months after minimally invasive coronary artery bypass grafting.
  
  
  METHODS
  In this dual-center study, 91 patients were prospectively enrolled to undergo minimally invasive coronary artery bypass grafting via a 4- to 7-cm left thoracotomy approach. The left internal thoracic artery, the ascending aorta for proximal anastomoses, and all coronary targets were directly accessed without endoscopic or robotic assistance. The study primary outcome was graft patency at 6 months, using 64-slice computed tomography angiography. Secondary outcomes included conversions to sternotomy and major adverse cardiovascular events (Clinical Trial Registration Unique identifier: NCT01334866).
  
  
  RESULTS
  The mean age of patients was 64 ± 8 years, the mean ejection fraction was 51% ± 11%, and there were 10 female patients (11%) in the study. Surgeries were performed entirely off-pump in 68 patients (76%). Complete revascularization was achieved in all patients, and the median number of grafts was 3. There was no perioperative mortality, no conversion to sternotomy, and 2 reopenings for bleeding. Transfusion occurred in 24 patients (26%). The median length of hospital stay was 4 days, and all patients were followed to 6 months, with no mortality or major adverse cardiovascular events. Six-month computed tomography angiographic graft patency was 92% for all grafts and 100% for left internal thoracic artery grafts.
  
  
  CONCLUSIONS
  Minimally invasive coronary artery bypass grafting is safe, feasible, and associated with excellent outcomes and graft patency at 6 months post-surgery.
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: mruel@ottawaheart.ca.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: Staten Island University Hospital, Staten Island, NY.
authors.forename: Masood A
authors.initials: MA
authors.lastname: Shariff
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Harry
authors.initials: H
authors.lastname: Lapierre
authors.affiliation: Staten Island University Hospital, Staten Island, NY.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Goyal
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
authors.affiliation: Staten Island University Hospital, Staten Island, NY.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sadel
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sohmer
authors.affiliation: Staten Island University Hospital, Staten Island, NY.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: McGinn
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009518:New York; D009864:Ontario; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: 23.1; 23.2; 28; 36.1; CABG; CAD; CCS; CTA; Canadian Cardiovascular Society; LAD; LITA; MICS; MIDCAB; SVG; computed tomography angiography; coronary artery bypass grafting; coronary artery disease; left anterior descending; left internal thoracic artery; minimally invasive cardiac surgery; minimally invasive direct coronary artery bypass; saphenous vein graft