title: Propensity Score Adjusted Comparison of MIDCAB Versus Full Sternotomy Left Anterior Descending Artery Revascularization.
abstract: OBJECTIVE
  Minimally invasive direct coronary artery bypass (MIDCAB) has been proposed as an attractive alternative to full sternotomy (FS) revascularization in isolated left anterior descending (LAD) artery disease not suitable for percutaneous coronary intervention. However, surgeons are still reluctant to perform MIDCAB owing to concerns about early and late outcomes. We aimed to compare short- and long-term outcomes after MIDCAB versus FS revascularization.
  
  
  METHODS
  Prospectively collected data from institutional database were reviewed. Data for late mortality were obtained from the General Register Office. MIDCAB was performed in 318 patients, whereas 159 had FS, according to the surgeon's preference, among 477 patients with isolated LAD disease. Inverse propensity score weighting was used to estimate treatment effects on short- and long-term outcomes.
  
  
  RESULTS
  In the propensity score-adjusted analysis, FS revascularization versus MIDCAB was associated increased rate of surgical site infection [4 (2.8%) versus 1 (0.7%); P = 0.04]. The 2 groups did not significantly differ with regard to other complications including operative mortality. Mean length of hospital stay was similar for the 2 groups. After a mean follow-up time of 6.2 years (interquartile range, 3.5-9.7 years), compared to MIDCAB, FS was not associated with an improved late survival (β coef, -1.42; standard error, 1.65; P = 0.39) or risk reduction for repeat revascularization (β coef, 1.22; standard error, 1.41; P = 0.15).
  
  
  CONCLUSIONS
  MIDCAB was associated with a trend toward better short-term outcomes and excellent long-term results comparable to FS revascularization. According to these findings, surgeons should not be reluctant to perform MIDCAB in isolated LAD disease.
authors.affiliation: From the Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.forename: Eman
authors.initials: E
authors.lastname: Alkizwini
authors.forename: Sapna
authors.initials: S
authors.lastname: Gupta
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D057216:Propensity Score; D011446:Prospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome