title: Minimally invasive coronary artery bypass grafting is associated with improved clinical outcomes.
abstract: OBJECTIVE
  Minimally invasive coronary artery bypass grafting (MICS CABG) via left minithoracotomy is an alternative to off-pump coronary artery bypass (OPCAB) via sternotomy. Our objective was to evaluate the clinical outcomes after MICS CABG versus OPCAB.
  
  
  METHODS
  The medical records of patients who underwent MICS CABG from December 2009 to December 2011 and OPCAB from January 2005 to April 2011 were reviewed. Patients who underwent OPCAB were matched 2:1 to patients who underwent MICS CABG by age, sex, preoperative ejection fraction, creatinine concentration, as well as history of diabetes and myocardial infarction.
  
  
  RESULTS
  A total of 130 MICS CABG patients were matched with 260 OPCAB patients. Mean bypasses in the MICS CABG and OPCAB groups were 2.1 and 3.2, respectively (P = 0.001). Extubation in the operating room (OR) occurred in 70.0% and 12.7% of patients in the MICS CABG and OPCAB groups, respectively (P = 0.001). Mean postoperative length of stay was 4 days for the MICS CABG patients versus 5 days for the OPCAB patients (P = 0.002) and 3.8 days versus 4.6 days for the MICS CABG patients extubated in the OR compared with those who remained intubated (P = 0.007). There were no 30-day mortalities in the MICS CABG group and 1 in the OPCAB group (P = 0.999). Thirty-day readmissions were similar, with 5.4% and 7.4% in the MICS CABG and OPCAB groups, respectively (P = 0.527).
  
  
  CONCLUSIONS
  Minimally invasive coronary artery bypass grafting is safe, and early clinical outcomes are comparable, if not superior in some respects, to OPCAB. Extubation in the OR is feasible, well tolerated, and associated with earlier discharge. Shorter hospital stays may decrease resource use and promote earlier return to activities; however, further research is needed.
authors.affiliation: From the *Department of Cardiothoracic Surgery, Gundersen Health System; and †Department of Research, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Prem
authors.initials: P
authors.lastname: Rabindranauth
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Burns
authors.forename: Todd T
authors.initials: TT
authors.lastname: Vessey
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mathiason
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.forename: Venki
authors.initials: V
authors.lastname: Paramesh
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome