Early and mid-term results of minimally invasive direct coronary artery bypass (MIDCAB) surgery

Aim: This study aimed to evaluate the early and mid-term outcomes of minimally invasive direct coronary artery bypass (MIDCAB) surgery for isolated left anterior descending artery (LAD) disease, with a primary focus on revascularization-free survival. Methods: A retrospective analysis was conducted on 155 consecutive patients who underwent MIDCAB at Santa Maria Hospital, Bari, Italy, between May 2017 and December 2023. All patients received a direct anastomosis of the left internal thoracic artery (LITA) to the LAD, with sequential grafting performed for those with concurrent diagonal artery disease. The primary endpoint was revascularization-free survival. The secondary endpoint was in-hospital mortality. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards models were employed for statistical analysis. Results: The median follow-up duration was 36 months [12-48]. No 30-day postoperative deaths occurred. The 5-year revascularization-free survival rate was 84.2% [77.4-91.7], and the overall 5-year survival rate was 90.5% [85.1-96.2]. Predictors of the primary endpoint were preoperative New York Heart Association (NYHA) class III (HR 5.898 [1.187-29.311], P = 0.030) and postoperative atrial fibrillation (HR 3.405 [1.232-9.415], P = 0.018). The incidence of complications was low, with no cerebrovascular events reported. Conclusion: MIDCAB for isolated LAD disease is safe, with satisfactory postoperative outcomes and excellent midterm survival. These findings align with existing literature, underscoring the procedure’s reproducibility. Further multicenter studies are needed to validate these results and compare MIDCAB versus PCI in treating isolated LAD disease.