title: Outcomes after different non-sternotomy approaches to left single-vessel revascularization: a comparative study with up to 10-year follow-up.
abstract: OBJECTIVE
  Various non-sternotomy approaches have been used for left internal mammary artery (LIMA) grafting in left single-vessel revascularization. The aim of this study was to evaluate the impact of three different non-sternotomy techniques on long-term outcomes after left single-vessel revascularization.
  
  
  METHODS
  A total of 502 patients having single-vessel LAD disease treated from April 2003 to May 2013 by minimally invasive direct coronary artery bypass grafting (MIDCAB), endoscopically assisted coronary artery bypass grafting (EACAB) or robotically assisted direct coronary artery bypass grafting (RADCAB) were reviewed. In all cases, distal anastomoses were performed through anterolateral minithoracotomy incisions. In-hospital and long-term (10-year) outcomes were compared using standard and propensity score-adjusted analyses.
  
  
  RESULTS
  One hundred and eighty-nine patients had MIDCAB, 76 had EACAB and 236 had RADCAB. After propensity score matching, RADCAB patients had significantly longer operative duration (P < 0.001), whereas MIDCAB and RADCAB patients had significantly higher incidence of postoperative angina over the follow-up (P = 0.034). The groups were comparable regarding in-hospital mortality and reintervention rate as well as incidence of myocardial infarction, reoperations, reinterventions and cardiac death. All groups showed comparable long-term survival (P = 0.943).
  
  
  CONCLUSIONS
  MIDCAB, EACAB and RADCAB are associated with similar long-term survival and incidence of major adverse cardiac events (MACEs) in single-vessel surgical revascularization. However, the endoscopic approach was found to be free from the disadvantages of longer operating duration observed in RADCAB or higher incidence of angina and shorter freedom from MACEs observed in both MIDCAB and RADCAB groups.
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany a.sabashnikov@rbht.nhs.uk.
authors: Anton
authors: A
authors: Sabashnikov
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Nikhil P
authors: NP
authors: Patil
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Alexander
authors: A
authors: Weymann
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Prashant N
authors: PN
authors: Mohite
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Bartlomiej
authors: B
authors: Zych
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Diana
authors: D
authors: García Sáez
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Aron-Frederik
authors: AF
authors: Popov
authors: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors: Thorsten
authors: T
authors: Wahlers
authors: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors: Thorsten
authors: T
authors: Wittwer
authors: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors: Jens
authors: J
authors: Wippermann
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Mohamed
authors: M
authors: Amrani
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Richard
authors: R
authors: Trimlett
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: André R
authors: AR
authors: Simon
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: John
authors: J
authors: Pepper
authors: Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
authors: Toufan
authors: T
authors: Bahrami
mesh_terms: D000368:Aged; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Endoscopically assisted coronary artery bypass grafting (EACAB); Left internal mammary artery harvesting; Minimally invasive direct coronary artery bypass grafting (MIDCAB); Robotically assisted direct coronary artery bypass grafting (RADCAB); Survival