Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.2.1. Inclusion Criteria
2.2.2. Exclusion Criteria
2.2.3. Screening and Data Extraction
2.2.4. Quality Assessment and Bias Evaluation
2.3. Data Synthesis
3. Results
3.1. Patients’ Profiles and Characteristics
3.2. Patient-Reported Outcomes and Complications
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Selection | Comparability | Outcome | Quality Score | Risk of Bias (0–3: High, 4–6: Moderate, 7–9: Low) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Article | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | ||
Olson [4] | * | * | * | * | ** | * | * | * | 9 | low |
Rosenblum [7] | * | * | * | * | ** | * | * | * | 9 | low |
Vicol [13] | * | * | * | * | ** | * | * | * | 9 | low |
Barış Çaynak [19] | * | * | * | * | 4 | moderate | ||||
Umberto Benedetto [20] | * | * | * | * | ** | * | * | * | 9 | low |
Yunpeng Ling [21] | * | * | * | * | * | 5 | moderate | |||
Kayatta MO [23] | * | * | * | * | 4 | moderate | ||||
Marc Ruel [25] | * | * | * | * | * | * | * | 7 | low | |
Shahzad G [26] | * | * | * | * | ** | * | * | * | 9 | low |
Vincenzo Giambruno [27] | * | * | * | * | ** | * | * | 8 | low | |
Ali Hage [10] | * | * | * | * | ** | * | * | * | 9 | low |
Joseph Lamelas [28] | * | * | * | * | * | * | * | 7 | low | |
Bob Kiaii [29] | * | * | * | ** | * | * | * | 8 | low | |
Joshua Michael Rosenblum [7] | * | * | * | ** | * | * | * | 8 | low | |
Alberto Repossini [30] | * | * | * | * | * | * | * | 7 | low | |
Florian Hecker [31] | * | * | * | ** | * | * | * | 8 | low | |
Shameer Khubber [32] | * | * | * | * | * | * | * | 7 | low | |
Nicholas R [33] | * | * | * | * | ** | * | * | * | 9 | low |
Jia-Ji Liu [34] | * | * | * | ** | * | * | * | 8 | low | |
Hiroto Kitahara [35] | * | * | * | * | ** | * | * | * | 9 | low |
Yugal K. Mishra [36] | * | * | * | * | ** | * | * | * | 9 | low |
Sanin Fazlinović [37] | * | * | * | * | ** | * | * | * | 9 | low |
Ho Young Hwang [38] | * | * | * | * | * | * | * | 7 | low | |
Wenhui Gong [39] | * | * | * | * | * | * | * | 7 | low | |
Carlo Antona [40] | * | * | * | * | ** | * | * | * | 9 | low |
Lin Liang [41] | * | * | * | * | * | * | 6 | moderate | ||
Zia K [42] | * | * | * | * | * | * | * | * | 8 | low |
Paweł Bugajski [44] | * | * | * | * | * | * | * | * | 8 | low |
Redoy Ranjan [45] | * | * | * | * | * | * | * | 7 | low | |
Marek Cisowskia [46] | * | * | * | * | * | * | * | * | 8 | low |
Husam H. Balkhy [47] | * | * | * | * | ** | * | * | * | 9 | low |
BH Kirmani [48] | * | * | * | * | ** | * | * | * | 9 | low |
Ali İhsan Tekin [49] | * | * | * | * | * | * | * | * | 8 | low |
Minoru Ono [50] | * | * | * | * | * | * | * | * | 7 | low |
Lufeng Zhang [51] | * | * | * | * | ** | * | * | * | 8 | low |
Hideaki Takai [52] | * | * | * | * | * | * | * | * | 7 | low |
Rashmi Birla [53] | * | * | * | * | ** | * | * | * | 9 | low |
Joseph McGinn [54] | * | * | * | * | ** | * | * | * | 9 | low |
Emad Barsoum [55] | * | * | * | * | * | * | * | * | 8 | low |
Diegeler [57] | * | * | * | * | ** | * | * | * | 8 | low |
Dong Li [58] | * | * | * | * | ** | * | * | * | 9 | low |
Do-Kyun Kim [60] | * | * | * | * | ** | * | * | * | 8 | low |
Oktar [61] | * | * | * | * | ** | * | * | * | 9 | low |
Raghuram [62] | * | * | * | * | ** | * | * | * | 8 | low |
Park [63] | * | * | * | * | ** | * | * | * | 9 | low |
Halkos, 2014 [65] | * | * | * | * | ** | * | * | * | 8 | low |
Appendix B
Author | Bias Arising from the Randomization Process | Bias Due to Deviations from Intended Interventions | Bias Due to Missing Outcome Data | Bias in Measurement of the Outcome | Bias in Selection of the Reported Result | Overall RoB |
---|---|---|---|---|---|---|
Taggart [1] | low | some concerns | low | low | low | low |
Shroyer [6] | low | some concerns | low | low | low | low |
Zenati, Marco [15] | low | some concerns | low | low | low | low |
Angelini [16] | low | some concerns | low | low | low | low |
Ming Hao Guo [18] | low | some concerns | low | low | low | low |
Meice Tian [22] | low | some concerns | low | low | low | low |
Weimar [24] | low | Some Concerns | low | low | Some Concerns | Some Concerns |
Anno Diegeler [43] | low | some concerns | some concerns | low | some concerns | low |
Stone [56] | low | Low | high | low | low | low |
Sajja [59] | low | Low | Some Concerns | Low | Some Concerns | Some Concerns |
Moussa [64] | low | Some Concerns | Some Concerns | Low | Some Concerns | Some Concerns |
Appendix C
Item | Bansal 2023 | Ullah 2023 | Benedetto 2009 | Kikuchi 2017 | Parnell 2018 | Hage 2019 | Ouzzani 2016 | Davierwala 2018 | Chivasso 2016 |
---|---|---|---|---|---|---|---|---|---|
A clearly stated aim | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
Inclusion of consecutive patients | 0 | 2 | 2 | 0 | 0 | 2 | 0 | 2 | 2 |
Prospective collection of data | 0 | 2 | 1 | 0 | 0 | 2 | 0 | 2 | 1 |
Endpoints appropriate to the aim of the study | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
Unbiased assessment of the study endpoint | 1 | 1 | 2 | 1 | 1 | 2 | 2 | 2 | 1 |
Follow-up period appropriate to the aim of the study | 0 | 2 | 2 | 2 | 0 | 2 | 0 | 2 | 2 |
Loss to follow-up less than 5% | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 1 | 1 |
Prospective calculation of the study size | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 1 | 1 |
An adequate control group | 0 | 1 | 2 | 1 | 0 | 2 | 0 | 1 | 2 |
Contemporary groups | 0 | 1 | 2 | 1 | 0 | 2 | 0 | 1 | 2 |
Baseline equivalence of groups | 0 | 1 | 2 | 1 | 0 | 2 | 0 | 1 | 2 |
Adequate statistical analyses | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
Total Score | 7 | 17 | 19 | 11 | 7 | 20 | 8 | 17 | 18 |
Appendix D
Title of the Systematic Review | Comparative the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review |
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Author and Affiliations |
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Supervisor/Project PI | Fatma E. Hassan Department of Medical Physiology, Batterjee Medical College, Jeddah 21442, Saudi Arabia [email protected] |
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Coronary artery bypass grafting (CABG) is the most effective surgical procedure for coronary artery disease and the leading global cause of morbidity and mortality. Most notably, open and minimally invasive CABG approaches have evolved with advances in surgical techniques and technology. The advantages and disadvantages of each procedure link to the differences between these two distinct surgical methods [70]. For years, CABG, an open-heart surgery, has been the primary method of coronary revascularization, requiring a sternotomy with cardiopulmonary bypass (CPB) on a heart-lung machine. This ensures complete revascularization and provides the surgeon with direct access to each of the coronary vessels. This technique has two major disadvantages: high rates of perioperative morbidity and long convalescent periods. They often experience longer in-hospital healthcare episodes followed by a prolonged recovery time, which may decrease their quality of life [71]. Conversely, the minimally invasive CABG procedures have emerged as a promising alternative. These approaches reduced the size and number of incisions required, resulting in reduced surgical trauma and, consequently, improved post-surgical recovery. Minimally invasive CABG comprises robot-assisted surgery, grafts with completely endoscopic treatments or thoracotomy incisions, and other techniques. The advocates of minimally invasive CABG contend that it offers the potential for reduced pain, a faster return to regular activities with shorter hospital stays, and better cosmetic results [72]. Whether open or minimally invasive CABG should be the surgical treatment depends on the patient, surgeon, and institution. However, the medical community continues to grapple with this issue. Although some research states that minimally invasive CABG similar to OPCAB could give similar or better results in mortality, morbidity, and long-term graft patency, others say open CABG has remained the gold standard due to its established record of outcomes and capacity for full revascularization [71,73]. | |
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This systematic review aims to evaluate and compare the effectiveness of open and minimally invasive approaches in Coronary Artery Bypass Grafting (CABG) procedures. | |
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Population, or participants and condition of interest | This includes patients of different ages, and genders, who have been diagnosed with coronary artery disease (CAD) in various healthcare settings. The condition of interest for this systematic review research is to investigate and compare the outcomes and effectiveness of open and minimally invasive approaches in CABG procedures. |
Interventions or exposures |
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Comparisons or control groups |
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Outcomes of interest | Surgical complications (Wound infection rate, Bleeding rate, Stroke rate, Angina recurrence rate, Length of hospital stay, and Mortality rate) |
Setting |
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Inclusion criteria |
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Exclusion criteria |
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Electronic databases |
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Keywords | (Coronary Artery Bypass Grafting OR Coronary Artery Bypass Surgery OR Coronary Artery Bypass OR Aortocoronary Bypass OR Bypass Surgery OR Coronary Artery Disease OR Aortocoronary OR CABG OR Open-heart surgery OR Minimally invasive surgery OR Endoscopic Surgery OR Surgical outcomes OR Mortality OR Graft patency OR Graft Occlusion OR Vascular Graft Restenosis OR Length of hospital stay) |
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Details of methods, number of reviewers, how agreements are to be reached and disagreements dealt with, etc. | Four main reviewers and a fifth to resolve any disagreements. Resolving any outstanding disagreements, an article by Dr. Fatma and Dr. Arwa. |
Quality assessment tools or checklists used with references or URLs |
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Narrative synthesis details of what and how synthesis will be performed | A narrative synthesis will be conducted alongside any meta-analysis and will be carried out using a framework that consists of four elements: 1—Developing a theory of how the intervention works, why, and for whom. 2—Developing a preliminary synthesis of findings of included studies. 3—Exploring relationships within and between studies. 4—Assessing the robustness of the synthesis. |
Meta-analysis details of what and how analysis and testing will be performed. If no meta-analysis is to be conducted, please give a reason. | Although a meta-analysis is planned, this will only become apparent when we see what data has been extracted and made available from the systematic review. Need to think about how heterogeneity will be explored. |
Grading evidence system used, if any, such as GRADE | GRADE will be used for evidence assessment. |
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Additional material summary tables, flowcharts, etc, to be included in the final paper | A flow chart of the whole process Protocol Data extraction from and tables Forest plots of studies are included in the final review. |
Appendix E
Section and Topic | Item # | Checklist Item | Location where Item Is Reported |
---|---|---|---|
Title | |||
Title | 1 | Identify the report as a systematic review. | Page 1; Lines 3 and 4 |
Abstract | |||
Abstract | 2 | See the PRISMA 2020 for Abstracts checklist. | Page 1; Lines 24 to 39 |
Introduction | |||
Rationale | 3 | Describe the rationale for this review in the context of existing knowledge. | Page 2; Lines 54 to 64 |
Objectives | 4 | Provide an explicit statement of the objective(s) or question(s) this review addresses. | Page 2; Lines 75 to 86 |
Methods | |||
Eligibility criteria | 5 | Specify the inclusion and exclusion criteria for this review and how studies were grouped for the syntheses. | Page 3; Lines 112 to 126 |
Information sources | 6 | Specify all databases, registers, websites, organizations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted. | Page 2 and 3; Lines 90 to 110 |
Search strategy | 7 | Present the full search strategies for all databases, registers and websites, including any filters and limits used. | Page 2 and 3; Lines 90 to 110 |
Selection process | 8 | Specify the methods used to decide whether a study met the inclusion criteria of this review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process. | Page 3; Lines 128 to 139 |
Data collection process | 9 | Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process. | Page 3; Lines 128 to 139 |
Data items | 10a | List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g., for all measures, time points, analyses), and if not, the methods used to decide which results to collect. | Page 4; Lines 153 to 165 |
10b | List and define all other variables for which data were sought (e.g., participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information. | Page 4; Lines 153 to 165 | |
Study risk of bias assessment | 11 | Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process. | Page 4; Lines 141 to 151 |
Effect measures | 12 | Specify for each outcome the effect measure(s) (e.g., risk ratio, mean difference) used in the synthesis or presentation of results. | ND |
Synthesis methods | 13a | Describe the processes used to decide which studies were eligible for each synthesis (e.g., tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)). | ND |
13b | Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions. | ND | |
13c | Describe any methods used to tabulate or visually display results of individual studies and syntheses. | ND | |
13d | Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used. | Page 4; Lines 153 to 161 | |
13e | Describe any methods used to explore possible causes of heterogeneity among study results (e.g., subgroup analysis, meta-regression). | Page 4; Lines 153 to 161 | |
13f | Describe any sensitivity analyses conducted to assess robustness of the synthesized results. | ND | |
Reporting bias assessment | 14 | Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases). | Page 4; Lines 141 to 151 |
Certainty assessment | 15 | Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome. | ND |
Results | |||
Study selection | 16a | Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in this review, ideally using a flow diagram. | Page 5; Lines 167 to 183 |
16b | Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded. | Page 5; Lines 168 to 174 | |
Study characteristics | 17 | Cite each included study and present its characteristics. | Page 6 to 14; Lines 184 to 217 |
Risk of bias in studies | 18 | Present assessments of risk of bias for each included study. | Page 17 to 23; Lines 333 to 356 |
Results of individual studies | 19 | For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g., confidence/credible interval), ideally using structured tables or plots. | Page 6 to 14; Lines 213 to 217 |
Results of syntheses | 20a | For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies. | Page 17 to 23; Lines 333 to 356 |
20b | Present results of all statistical syntheses conducted. If meta-analysis was conducted, present for each the summary estimate and its precision (e.g., confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect. | ND | |
20c | Present results of all investigations of possible causes of heterogeneity among study results. | ND | |
20d | Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results. | ND | |
Reporting biases | 21 | Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed. | ND |
Certainty of evidence | 22 | Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed. | ND |
Discussion | |||
Discussion | 23a | Provide a general interpretation of the results in the context of other evidence. | Page 15; Lines 260 to 289 |
23b | Discuss any limitations of the evidence included in this review. | Page 16; Lines 291 to 298 | |
23c | Discuss any limitations of this review process used. | Page 16; Lines 291 to 298 | |
23d | Discuss the implications of the results for practice, policy, and future research. | Page 16; Lines 299 to 305 | |
Other information | |||
Registration and protocol | 24a | Provide registration information for this review, including register name and registration number, or state that this review was not registered. | Page 2; Lines 90 to 92 |
24b | Indicate where this review protocol can be accessed, or state that a protocol was not prepared. | Page 24; Lines 359 to 362 | |
24c | Describe and explain any amendments to information provided at registration or in the protocol. | Page 24; Lines 359 to 362 | |
Support | 25 | Describe sources of financial or non-financial support for this review and the role of the funders or sponsors in this review. | Page 17; Line 320 |
Competing interests | 26 | Declare any competing interests of review authors. | Page 17; Line 332 |
Availability of data, code, and other materials | 27 | Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in this review. | Pages 17 to 27; Lines 333 to 362 |
References
- Taggart, D.P.; Altman, D.G.; Gray, A.M.; Lees, B.; Gerry, S.; Benedetto, U.; Flather, M. Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts. N. Engl. J. Med. 2016, 375, 2540–2549. [Google Scholar] [CrossRef] [PubMed]
- Bansal, A.; Hiwale, K. Updates in the Management of Coronary Artery Disease: A Review Article. Cureus 2023, 15, e50644. [Google Scholar] [CrossRef] [PubMed]
- Ullah, M.; Wahab, A.; Khan, S.U.; Zaman, U.; Rehman, K.U.; Hamayun, S.; Naeem, M.; Ali, H.; Riaz, T.; Saeed, S.; et al. Stent as a Novel Technology for Coronary Artery Disease and Their Clinical Manifestation. Curr. Probl. Cardiol. 2023, 48, 101415. [Google Scholar] [CrossRef] [PubMed]
- Olson, P.; Cinelli, M.; Rahming, H.S.; Vazzana, T.; Spagnola, J.; Barsoum, E.; Assaad, M.; Tamburrino, F.; Lafferty, J. Repeat Revascularization Post Coronary Artery Bypass Grafting: Comparing Minimally Invasive and Traditional Sternotomy Techniques in 1468 Cases. Cureus 2022, 14, e25687. [Google Scholar] [CrossRef]
- Benedetto, U.; Melina, G.; Angeloni, E.; Refice, S.; Roscitano, A.; Fiorani, B.; Di Nucci, G.D.; Sinatra, R. Coronary artery bypass grafting versus drug-eluting stents in multivessel coronary disease. A meta-analysis on 24,268 patients. Eur. J. Cardio-Thorac. Surg. 2009, 36, 611–615. [Google Scholar] [CrossRef]
- Shroyer, A.L.; Grover, F.L.; Hattler, B.; Collins, J.F.; McDonald, G.O.; Kozora, E.; Lucke, J.C.; Baltz, J.H.; Novitzky, D. On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. N. Engl. J. Med. 2009, 361, 1827–1837. [Google Scholar] [CrossRef]
- Rosenblum, J.M.; Binongo, J.; Wei, J.; Liu, Y.; Leshnower, B.G.; Chen, E.P.; Miller, J.S.; Macheers, S.K.; Lattouf, O.M.; Guyton, R.A.; et al. Priorities in coronary artery bypass grafting: Is midterm survival more dependent on completeness of revascularization or multiple arterial grafts? J. Thorac. Cardiovasc. Surg. 2021, 161, 2070–2078.e6. [Google Scholar] [CrossRef]
- Kikuchi, K.; Mori, M. Minimally invasive coronary artery bypass grafting: A systematic review. Asian Cardiovasc. Thorac. Ann. 2017, 25, 364–370. [Google Scholar] [CrossRef]
- Parnell, A.; Prince, M. Anaesthesia for minimally invasive cardiac surgery. BJA Educ. 2018, 18, 323–330. [Google Scholar] [CrossRef]
- Hage, A.; Giambruno, V.; Jones, P.; Chu, M.W.; Fox, S.; Teefy, P.; Lavi, S.; Bainbridge, D.; Harle, C.; Iglesias, I.; et al. Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis with Long-Term Follow-up. J. Am. Heart Assoc. 2019, 8, e014204. [Google Scholar] [CrossRef]
- Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009, 6, e1000097. [Google Scholar] [CrossRef] [PubMed]
- Chaabna, K.; Cheema, S.; Abraham, A.; Alrouh, H.; Lowenfels, A.B.; Maisonneuve, P.; Mamtani, R. Systematic overview of hepatitis C infection in the Middle East and North Africa. World J. Gastroenterol. 2018, 24, 3038–3054. [Google Scholar] [CrossRef] [PubMed]
- Vicol, C.; Nollert, G.; Mair, H.; Samuel, V.; Lim, C.; Tiftikidis, M.; Eifert, S.; Reichart, B. Midterm results of beating heart surgery in 1-vessel disease: Minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy. Heart Surg. Forum 2003, 6, 341–344. Available online: https://pubmed.ncbi.nlm.nih.gov/15011666 (accessed on 26 January 2024). [PubMed]
- Davierwala, P.M.; Leontyev, S.; Garbade, J.; Lehmann, S.; Holzhey, D.; Misfeld, M.; Borger, M.A. Off-pump coronary artery bypass surgery with bilateral internal thoracic arteries: The Leipzig experience. Ann. Cardiothorac. Surg. 2018, 7, 483–491. [Google Scholar] [CrossRef] [PubMed]
- Zenati, M.A.; Bhatt, D.L.; Bakaeen, F.G.; Stock, E.M.; Biswas, K.; Gaziano, J.M.; Kelly, R.F.; Tseng, E.E.; Bitondo, J.; Quin, J.A.; et al. Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass. N. Engl. J. Med. 2019, 380, 132–141. [Google Scholar] [CrossRef]
- Angelini, G.D.; Culliford, L.; Smith, D.K.; Hamilton, M.C.K.; Murphy, G.J.; Ascione, R.; Baumbach, A.; Reeves, B.C. Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: Long-term follow-up of 2 randomized controlled trials. J. Thorac. Cardiovasc. Surg. 2009, 137, 295–303.e5. [Google Scholar] [CrossRef]
- Chivasso, P.; Guida, G.A.; Fudulu, D.; Bruno, V.D.; Marsico, R.; Sedmakov, H.; Zakkar, M.; Rapetto, F.; Bryan, A.J.; Angelini, G.D. Impact of off-pump coronary artery bypass grafting on survival: Current best available evidence. J. Thorac. Dis. 2016, 8, S808–S817. [Google Scholar] [CrossRef]
- Guo, M.H.; Wells, G.A.; Glineur, D.; Fortier, J.; Davierwala, P.M.; Kikuchi, K.; Lemma, M.G.; Mishra, Y.K.; McGinn, J.; Ramchandani, M.; et al. Minimally Invasive coronary surgery compared to STernotomy coronary artery bypass grafting: The MIST trial. Contemp. Clin. Trials 2019, 78, 140–145. [Google Scholar] [CrossRef]
- Çaynak, B.; Sicim, H. Evaluation of anastomosis quality with intraoperative transit time flowmeter in minimally invasive multi-vessel coronary artery bypass grafting via left anterior mini-thoracotomy. Turk. J. Thorac. Cardiovasc. Surg. 2023, 31, 56–62. [Google Scholar] [CrossRef]
- Benedetto, U.; Puskas, J.; Kappetein, A.P.; Brown, W.M.; Horkay, F.; Boonstra, P.W.; Bogáts, G.; Noiseux, N.; Dressler, O.; Angelini, G.D.; et al. Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease. J. Am. Coll. Cardiol. 2019, 74, 729–740. [Google Scholar] [CrossRef]
- Ling, Y.; Bao, L.; Yang, W.; Chen, Y.; Gao, Q. Minimally invasive direct coronary artery bypass grafting with an improved rib spreader and a new-shaped cardiac stabilizer: Results of 200 consecutive cases in a single institution. BMC Cardiovasc. Disord. 2016, 16, 42. [Google Scholar] [CrossRef] [PubMed]
- Tian, M.; Wang, X.; Sun, H.; Feng, W.; Song, Y.; Lu, F.; Wang, L.; Wang, Y.; Xu, B.; Wang, H.; et al. No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After Coronary Artery Bypass Grafting Surgery: Multicenter Randomized, Controlled Trial. Circulation 2021, 144, 1120–1129. [Google Scholar] [CrossRef] [PubMed]
- Kayatta, M.O.; Halkos, M.E.; Narayan, P. Minimally invasive coronary artery bypass grafting. Indian J. Thorac. Cardiovasc. Surg. 2018, 34, 302–309. [Google Scholar] [CrossRef] [PubMed]
- Weimar, C.; Bilbilis, K.; Rekowski, J.; Holst, T.; Beyersdorf, F.; Breuer, M.; Dahm, M.; Diegeler, A.; Kowalski, A.; Martens, S.; et al. Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting. Stroke 2017, 48, 2769–2775. [Google Scholar] [CrossRef] [PubMed]
- Ruel, M.; Shariff, M.A.; Lapierre, H.; Goyal, N.; Dennie, C.; Sadel, S.M.; Sohmer, B.; McGinn, J.T. Results of the minimally invasive coronary artery bypass grafting angiographic patency study. J. Thorac. Cardiovasc. Surg. 2014, 147, 203–209. [Google Scholar] [CrossRef]
- Raja, S.G.; Garg, S.; Rochon, M.; Daley, S.; De Robertis, F.; Bahrami, T. Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting. Ann. Cardiothorac. Surg. 2018, 7, 621–627. [Google Scholar] [CrossRef]
- Giambruno, V.; Jones, P.; Khaliel, F.; Chu, M.W.; Teefy, P.; Sridhar, K.; Cucchietti, C.; Barnfield, R.; Kiaii, B. Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting. Ann. Thorac. Surg. 2018, 105, 1330–1335. [Google Scholar] [CrossRef]
- Lamelas, J.; Mawad, M.; Williams, R.; Weiss, U.K.; Zhang, Q.; LaPietra, A. Isolated and concomitant minimally invasive mini-thoracotomy aortic valve surgery. J. Thorac. Cardiovasc. Surg. 2018, 155, 926–936.e2. [Google Scholar] [CrossRef]
- Kiaii, B.; McClure, R.S.; Stitt, L.; Rayman, R.; Dobkowski, W.B.; Jablonsky, G.; Novick, R.J.; Boyd, W.D. Prospective Angiographic Comparison of Direct, Endoscopic, and Telesurgical Approaches to Harvesting the Internal Thoracic Artery. Ann. Thorac. Surg. 2006, 82, 624–628. [Google Scholar] [CrossRef]
- Repossini, A.; Di Bacco, L.; Nicoli, F.; Passaretti, B.; Stara, A.; Jonida, B.; Muneretto, C. Minimally invasive coronary artery bypass: Twenty-year experience. J. Thorac. Cardiovasc. Surg. 2019, 158, 127–138.e1. [Google Scholar] [CrossRef]
- Hecker, F.; Von Zeppelin, M.; Van Linden, A.; Scholtz, J.E.; Fichtlscherer, S.; Hlavicka, J.; Walther, T.; Holubec, T. Right-Sided Minimally Invasive Direct Coronary Artery Bypass: Clinical Experience and Perspectives. Medicina 2023, 59, 907. [Google Scholar] [CrossRef] [PubMed]
- Khubber, S.; Chana, R.; Meenakshisundaram, C.; Dhaliwal, K.; Gad, M.; Kaur, M.; Banerjee, K.; Verma, B.R.; Shekhar, S.; Khan, M.Z.; et al. Coronary artery aneurysms: Outcomes following medical, percutaneous interventional and surgical management. Open Heart 2021, 8, e001440. [Google Scholar] [CrossRef] [PubMed]
- Teman, N.R.; Hawkins, R.B.; Charles, E.J.; Mehaffey, J.H.; Speir, A.M.; Quader, M.A.; Ailawadi, G. Minimally Invasive vs Open Coronary Surgery: A Multi-Institutional Analysis of Cost and Outcomes. Ann. Thorac. Surg. 2021, 111, 1478–1484. [Google Scholar] [CrossRef] [PubMed]
- Liu, J.J.; Kong, Q.Y.; You, B.; Liang, L.; Xiao, W.; Ma, X.L.; Pan, F.; Chi, L.Q. Surgical Challenges in Multi-Vessel Minimally Invasive Coronary Artery Bypass Grafting. J. Interv. Cardiol. 2021, 2021, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Kitahara, H.; Hirai, T.; McCrorey, M.; Patel, B.; Nisivaco, S.; Nathan, S.; Balkhy, H.H. Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions. J. Thorac. Cardiovasc. Surg. 2019, 157, 1829–1836.e1. [Google Scholar] [CrossRef]
- Mishra, Y.K.; Wasir, H.; Rajneesh, M.; Sharma, K.K.; Mehta, Y.; Trehan, N. Robotically enhanced coronary artery bypass surgery. J. Robot. Surg. 2007, 1, 221–226. [Google Scholar] [CrossRef]
- Fazlinović, S.; Wallinder, A.; Dellborg, M.; Furenäs, E.; Eriksson, P.; Synnergren, M.; Lidén, H. Outcome and survival after open heart surgery for adults with congenital heart disease—A single center experience. Scand. Cardiovasc. J. 2021, 55, 345–353. [Google Scholar] [CrossRef]
- Hwang, H.Y.; Paeng, J.C.; Kang, J.; Jang, M.J.; Kim, K.B. Relation between functional coronary artery stenosis and graft occlusion after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 2021, 161, 1010–1018.e1. [Google Scholar] [CrossRef]
- Gong, W.; Cai, J.; Wang, Z.; Chen, A.; Ye, X.; Li, H.; Zhao, Q. Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting. J. Thorac. Dis. 2016, 8, 459–468. [Google Scholar] [CrossRef]
- Antona, C.; Pompilio, G.; Lotto, A.A.; Di Matteo, S.; Agrifoglio, M.; Biglioli, P. Video-assisted minimally invasive coronary bypass surgery without cardiopulmonary bypass. Eur. J. Cardio-Thorac. Surg. 1998, 14, 62–67. [Google Scholar] [CrossRef]
- Liang, L.; Ma, X.; Kong, Q.; Xiao, W.; Liu, J.; Chi, L.; Zhu, J. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: A single-center retrospective cohort study. Cardiovasc. Diagn. Ther. 2022, 12, 378–388. [Google Scholar] [CrossRef] [PubMed]
- Zia, K.; Mangi, A.R.; Minhaj, S.; Tariq, K.; Rabbi, F.; Musharaf, M.; Awan, M.A.B.; Memon, R.A.; Rathore, A.R.; Chaudry, P.A. An Overview of First 100 Cardiac Surgery Cases at a Newly Developed Satellite Center in Sukkur, Pakistan. Cureus 2020, 12, e8490. [Google Scholar] [CrossRef] [PubMed]
- Diegeler, A.; Falk, V.; Matin, M.; Battellini, R.; Walther, T.; Autschbach, R.; Mohr, F.W. Minimally invasive coronary artery bypass grafting without cardiopulmonary bypass: Early experience and follow-up. Ann. Thorac. Surg. 1998, 66, 1022–1025. [Google Scholar] [CrossRef] [PubMed]
- Bugajski, P.; Greberski, K.; Kuzemczak, M.; Kalawski, R.; Jarząbek, R.; Siminiak, T. Impact of previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting. Kardiol. Pol. 2018, 76, 953–959. [Google Scholar] [CrossRef] [PubMed]
- Ranjan, R.; Sales, K.M.; Adhikary, A.B. Computed Tomography-Based Angiographic Evaluation of Graft Patency Rate after Coronary Artery Bypass Graft Surgery in Bangladesh. Cureus 2022, 14, e28902. [Google Scholar] [CrossRef]
- Cisowski, M.; Morawski, W.; Drzewiecki, J.; Kruczak, W.; Toczek, K.; Bis, J.; Bochenek, A. Integrated minimally invasive direct coronary artery bypass grafting and angioplasty for coronary artery revascularization. Eur. J. Cardio-Thorac. Surg. 2002, 22, 261–265. [Google Scholar] [CrossRef]
- Balkhy, H.H.; Nisivaco, S.; Kitahara, H.; Torregrossa, G.; Patel, B.; Grady, K.; Coleman, C. Robotic off-pump totally endoscopic coronary artery bypass in the current era: Report of 544 patients. Eur. J. Cardio-Thorac. Surg. 2021, 61, 439–446. [Google Scholar] [CrossRef]
- Kirmani, B.; Power, S.; Zacharias, J. Long-term survival after endoscopic vein harvest for coronary artery bypass grafting. Ann. R. Coll. Surg. Engl. 2020, 102, 422–428. [Google Scholar] [CrossRef]
- Tekin, A.İ.; Arslan, Ü. Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy. Videosurgery Other Miniinvasive Tech. 2017, 3, 285–290. [Google Scholar] [CrossRef]
- Ono, M.; Wolf, R.K.; Angouras, D.C.; Brown, D.A.; Goldstein, A.H.; Michler, R.E. Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant. Eur. J. Cardio-Thorac. Surg. 2002, 21, 1061–1072. [Google Scholar] [CrossRef]
- Zhang, L.; Cui, Z.; Song, Z.; Yang, H.; Fu, Y.; Gong, Y.; Ling, Y. Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization—Analysis of 300 cases. Videosurgery Other Miniinvasive Tech. 2015, 10, 548–554. [Google Scholar] [CrossRef] [PubMed]
- Takai, H.; Kobayashi, J.; Tagusari, O.; Bando, K.; Niwaya, K.; Nakajima, H.; Yagihara, T.; Kitamura, S. Off-Pump Coronary Artery Bypass Grafting for Acute Myocardial Infarction. Circ. J. 2006, 70, 1303–1306. [Google Scholar] [CrossRef] [PubMed]
- Birla, R.; Patel, P.; Aresu, G.; Asimakopoulos, G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann. R. Coll. Surg. Engl. 2013, 95, 481–485. [Google Scholar] [CrossRef] [PubMed]
- McGinn, J.T.; Usman, S.; Lapierre, H.; Pothula, V.R.; Mesana, T.G.; Ruel, M. Minimally Invasive Coronary Artery Bypass Grafting: Dual-Center Experience in 450 Consecutive Patients. Circulation 2009, 120 (Suppl. S1), S78–S84. [Google Scholar] [CrossRef]
- Barsoum, E.A.; Azab, B.; Shah, N.; Patel, N.; Shariff, M.A.; Lafferty, J.; Nabagiez, J.P.; McGinn, J.T. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur. J. Cardio-Thorac. Surg. 2014, 47, 862–867. [Google Scholar] [CrossRef]
- Stone, G.W.; Sabik, J.F.; Serruys, P.W.; Simonton, C.A.; Généreux, P.; Puskas, J.; Kandzari, D.E.; Morice, M.C.; Lembo, N.; Brown, W.M.; et al. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N. Engl. J. Med. 2016, 375, 2223–2235. [Google Scholar] [CrossRef]
- Diegeler, A.; Matin, M.; Kayser, S.; Binner, C.H.; Autschbach, R.; Battellini, R.; Krankenberg, H.; Mohr, F.W. Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach1. Eur. J. Cardio-Thorac. Surg. 1999, 15, 680–684. [Google Scholar] [CrossRef]
- Li, D.; Guo, P.; Chen, L.; Wu, Y.; Wang, G.; Xiao, C. Outcomes of Surgical Patch Angioplasty of the Coronary Artery for Diffuse Coronary Artery Disease. Braz. J. Cardiovasc. Surg. 2020, 35, 706–712. [Google Scholar] [CrossRef]
- Sajja, L.R.; Sarkar, K.; Mannam, G.; Kodali, V.K.K.; Padmanabhan, C.; Peter, S.; Mulay, A.; Beri, P. Graft patency at 3 months after off- and on-pump coronary bypass surgery: A randomized trial. Indian J. Thorac. Cardiovasc. Surg. 2019, 36, 93–104. [Google Scholar] [CrossRef]
- Kim, D.K.; Yoo, K.J.; Hong, Y.S.; Chang, B.C.; Kang, M.S. Clinical Outcome of Urgent Coronary Artery Bypass Grafting. J. Korean Med. Sci. 2007, 22, 270. [Google Scholar] [CrossRef]
- Oktar, G.; Imren, V.; Erer, D.; Iriz, E.; Gokgoz, L.; Soncul, H. Coronary artery bypass graft surgery in the elderly patients. Open Med. 2009, 4, 218–221. [Google Scholar] [CrossRef]
- Raghuram, A.R.R.; Subramanyan, K.; Sivakumaran, S.; Chandrasekar, P.; Harikrishnan, S.; Arunkumar, G. Graft patency study in off-pump coronary artery bypass surgery. Indian J. Thorac. Cardiovasc. Surg. 2017, 34, 6–10. [Google Scholar] [CrossRef]
- Park, D.W.; Ahn, J.M.; Yun, S.C.; Yoon, Y.H.; Kang, D.Y.; Lee, P.H.; Lee, S.W.; Park, S.W.; Seung, K.B.; Gwon, H.C.; et al. 10-Year Outcomes of Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease. J. Am. Coll. Cardiol. 2018, 72, 2813–2822. [Google Scholar] [CrossRef] [PubMed]
- Moussa, I.; Oetgen, M.; Subramanian, V.; Kobayashi, Y.; Patel, N.; Moses, J. Frequency of early occlusion and stenosis in bypass grafts after minimally invasive direct coronary arterial bypass surgery. Am. J. Cardiol. 2001, 88, 311–313. [Google Scholar] [CrossRef] [PubMed]
- Halkos, M.E.; Liberman, H.A.; Devireddy, C.; Walker, P.; Finn, A.V.; Jaber, W.; Guyton, R.A.; Puskas, J.D. Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery. J. Thorac. Cardiovasc. Surg. 2014, 147, 179–185. [Google Scholar] [CrossRef]
- Bachar, B.J.; Manna, B. Coronary Artery Bypass Graft. StatPearls—NCBI Bookshelf. Available online: https://www.ncbi.nlm.nih.gov/books/NBK507836/ (accessed on 1 January 2024).
- Coerkamp, C.F.; Hoogewerf, M.; Van Putte, B.P.; Appelman, Y.; Doevendans, P.A. Revascularization strategies for patients with established chronic coronary syndrome. Eur. J. Clin. Investig. 2022, 52, e13787. [Google Scholar] [CrossRef]
- Lin, T.H.; Wang, C.W.; Shen, C.H.; Chang, K.H.; Lai, C.H.; Liu, T.J.; Chen, K.J.; Chen, Y.W.; Lee, W.L.; Su, C.S. Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice. Medicine 2021, 100, e23830. [Google Scholar] [CrossRef]
- Park, S.; Park, S.J.; Park, D.W. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Revascularization of Left Main Coronary Artery Disease. Korean Circ. J. 2023, 53, 113. [Google Scholar] [CrossRef]
- Gray, D.T.; Veenstra, D.L. Comparative economic analyses of minimally invasive direct coronary artery bypass surgery. J. Thorac. Cardiovasc. Surg. 2003, 125, 618–624. [Google Scholar] [CrossRef]
- Skeffington, K.L.; Moscarelli, M.; Abdul-Ghani, S.; Fiorentino, F.; Emanueli, C.; Reeves, B.C.; Punjabi, P.P.; Angelini, G.D.; Suleiman, M.-S. Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery. Front. Cardiovasc. Med. 2022, 9, 911557. [Google Scholar] [CrossRef]
- Bonatti, J.; Wallner, S.; Crailsheim, I.; Grabenwöger, M.; Winkler, B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J. Thorac. Dis. 2021, 13, 1922–1944. [Google Scholar] [CrossRef] [PubMed]
- Van Praet, K.M.; Kofler, M.; Shafti, T.Z.N.; Al, A.A.E.; Van Kampen, A.; Amabile, A.; Torregrossa, G.; Kempfert, J.; Falk, V.; Balkhy, H.H.; et al. Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature. Interv. Cardiol. Rev. Res. Resour. 2021, 16, e08. [Google Scholar] [CrossRef] [PubMed]
Group A | ||||||
Open Approaches in CABG | ||||||
Authors | Wound infection rate | Bleeding rate | Stroke rate | Angina recurrence rate | Length of hospital stay | Mortality rate |
Calin Vicol [13] | 0% | 2.30% | 2% | 27% | 16 days | 4% |
Piroze M [14] | 0.90% | 1.90% | 0.80% | 11% | 19 days | 0.60% |
Marco A [15] | 3.10% | 5.90% | 5.90% | 8% | 8 days | 8% |
Gianni D [16] | 25% | 10.60% | 1% | 4.70% | 38 days | 5% |
Pierpaolo Chivasso [17] | / | / | / | 25.60% | / | 7% |
Ming Hao Guo [18] | 47% | / | / | / | 6 days | 4% |
Group B | ||||||
Minimally Invasive Approaches in CABG | ||||||
Authors | Wound infection rate | Bleeding rate | Stroke rate | Angina recurrence rate | Length of hospital stay | Mortality rate |
Calin Vicol [13] | 5% | 1.70% | 7% | 40% | 138 days | 0% |
Piroze M [14] | / | / | / | / | / | / |
Marco A [15] | 1.40% | 6.00% | 3.20% | 6% | 11 days | 6.40% |
Gianni D [16] | 31% | 11% | 2% | 2.30% | 21 days | 10% |
Pierpaolo Chivasso [17] | / | / | / | 11.40% | / | 5.30% |
Ming Hao Guo [18] | 16% | / | / | / | 5 days | 1.30% |
Authors | Country | Study Design | Open CABG Patients (N) | Minimally Invasive CABG Patients (N) | Major Complications | Conclusion | Evidence Level |
Calin Vicol [13] | Germany | Retrospective Cohort | 45 | 57 | Open CABG: recurrent angina (27%), bleeding (2.3%), mortality (4%). Minimally Invasive CABG: wound infection (5%), recurrent angina (40%), bleeding (1.7%). | The technical complexity of MIDCAB surpasses OPCAB, so skilled surgeons are requested. | III |
Piroze M [14] | Germany | Observational | 5130 | 0 | Open CABG: arrhythmias (19.7%), wound infection (0.9%), bleeding (1.9%), mortality (0.6%). | For OPCAB, using bilateral skeletonized ITAs is safe and effective. | III |
Marco A [15] | USA | Randomized trials | 574 | 576 | Open CABG: wound infection (3.1%), recurrent angina (8%), MI (5.9%), mortality (8%). Minimally Invasive CABG: wound infection (1.4%), recurrent angina (6%), MI (4.7%), mortality (6.4%). | In CABG surgeries, both open and minimally invasive procedures yield similar long-term outcomes, with the minimally invasive method offering a slight advantage in reducing wound infections. | I |
Gianni D [16] | United Kingdom | Randomized trials | 201 | 200 | Open CABG: wound infection (25%), bleeding (10.6%), MI (1.0%), mortality (5.0%). Minimally Invasive CABG: wound infection (31%), bleeding (11%), MI (2.0%), mortality (10%). | OPCAB and CABG with cardiopulmonary bypass have comparable long-term health outcomes. | I |
Pierpaolo Chivasso [17] | United Kingdom | Meta-analyses of RCTS | 4752 | 2203 | Open CABG: recurrent angina (25.6%), mortality (7.0%). Minimally Invasive CABG: recurrent angina (11.4%), mortality (5.3%). | The long-term benefits of off-pump CABG versus on-pump CABG remain uncertain, with existing studies showing mixed results due to methodological issues. More robust research is needed to clarify the long-term outcomes of these methods. | II |
Ming Hao Guo [18] | Canada | Randomized Clinical Trial | 64 | 450 | Open CABG: None. Minimally Invasive CABG: conversion to sternotomy (3.8%), use of cardiopulmonary bypass (7.6%), mortality (1.3%). | Sternotomy CABG has a notable effect on quality of life. MICS-CABG is comparatively safer. | II |
Barış Çaynak [19] | Turkey | Retrospective study | 0 | 45 | Minimally Invasive CABG: AF (11%), pleural effusion (6.7%). | The significance of employing an intraoperative flowmeter to assess the patency of the graft and the quality of the anastomosis. | III |
Umberto Benedetto [20] | Germany | Retrospective post hoc RCT | 923 | 0 | Open CABG: MI (58%), mortality (5.0%). | OPCAB is linked to a higher risk of death within 3 years and a lower rate of revascularization in the coronary arteries that supply the inferolateral wall. | III |
Yunpeng Ling [21] | China | Descriptive, non-experimental | 0 | 200 | Minimally Invasive CABG: AF (7.2%), mortality (0.7%). | Utilization of enhanced retractor and stabilizer in MIDCAB has the potential to yield positive results. | III |
Meice Tian [22] | China | Randomized controlled trial | 2655 | 0 | Open CABG: wound infection (4.3%), recurrent angina (2.3%), bleeding (1.7%), MI (0.6%), mortality (1.1%). | Using the no-touch technique for vein graft harvesting greatly reduced the chance of vein graft occlusion and improved the patient’s prognosis. | I |
Kayatta MO [23] | India | Retrospective observational | 0 | 450 | Minimally Invasive CABG: wound infection (0.9%), pneumothorax (3.1%), pleural effusion (9.1%), recurrent angina (1.6%), bleeding (1.1%), MI (1.1%). | The success of MICS-CABG relies heavily on meticulous patient selection. | III |
Weimar [24] | Germany | Randomized Clinical Trial | 129 | 0 | Open CABG: MI (1%). | For patients with severe CAD undergoing CABG, combining carotid endarterectomy with CABG does not appear to offer significant advantages over isolated CABG. The study’s early termination limits the findings, but the data suggest that isolated CABG may lead to better outcomes. We need further follow-up to confirm long-term effects. | I |
Marc Ruel [25] | Canada | Cohort | 0 | 91 | Minimally Invasive CABG: pleural effusion (15%), AF (17%), renal insufficiency (1.1%), wound infection (2.2%). | MICS-CABG can effectively revascularize, similar to regular CABG. | I |
Shahzad G [26] | Canada | Retrospective Cohort | 160 | 668 | Open CABG: bleeding (2.5%), a wound infection (1.9%), mortality (2.5%). Minimally Invasive CABG: bleeding (3.1%), wound infection (2.4%), mortality (2.0%). | The validity and effectiveness of MIDCAB as a grafting method for the LAD artery. MIDCAB is a good alternative to traditional CABG for people with a single proximal LAD stenosis. | III |
Vincenzo Giambruno [27] | Canada | Retrospective comparative analysis | 546 | 144 | Open CABG: bleeding (1.7%), MI (1.1%), stroke (2.4%), mortality (1.3%). Minimally Invasive CABG: bleeding (2.8%), MI (1.4%), stroke (2.1%). | HCR is potentially linked to a reduction in hospital mortality rates and shorter hospital stays in comparison to on-pump CABG. | III |
Ali Hage [10] | USA | Retrospective comparative analysis | 216 | 147 | Open CABG: bleeding (1.5%), MI (0.5%), hemodialysis (0.5%), mortality (1.0%). Minimally Invasive CABG: bleeding (3.5%), MI (1.4%). | HCR is a viable substitute for unsuitable multivessel PCI, especially in those exhibiting a low-intermediate SYNTAX score. | III |
Joseph Lamelas [28] | USA | Retrospective cohort study | 0 | 1396 | Minimally Invasive CABG: bleeding (0.8%), postoperative pacemakers (3.1%), stroke (0.8%). | Minimally invasive right thoracotomy aortic valve surgery, including both stand-alone and concurrent AVR surgeries, is a viable technique. | III |
Bob Kiaii [29] | Canada | Prospective cohort | 50 | 100 | Open CABG: None. Minimally Invasive CABG: None. | The ITA can be taken out using minimally invasive videoscopic and robotic-assisted telesurgical techniques, which are both safe and effective. | II |
Joshua Michael Rosenblum [7] | USA | Retrospective cohort | 17411 | 0 | Open CABG: stroke (1.3%), AF (22.5%), pneumonia (3.8%), renal failure (3.0%), mortality (13.4%). | CRV has a higher survival benefit than IRV. MA-CABG has higher survival rates than SA-CABG. | II |
Alberto Repossini [30] | Italy | Retrospective analysis | 0 | 1060 | Minimally Invasive CABG: stroke (0.3%), angina (7.2%), mortality (0.8%). | MIDCAB without CPB is safe when revascularizing the LAD artery. | III |
Florian Hecker [31] | Germany | Prospective study analysis | 0 | 11 | Minimally Invasive CABG: wound infection (9.1%), revascularization after surgery (18.2%). | Right-sided MIDCAB in individuals diagnosed with complicated CAD specifically affecting the RCA is safe. | II |
Shameer Khubber [32] | USA | Retrospective Cohort | 176 | 282 | Open CABG: None. Minimally Invasive CABG: None. | Clinicians should take a personalized approach because the long-term risks of MACCE are similar to treating CAAs with medicine, PCI, and surgery CABG. | III |
Nicholas R [33] | USA | Propensity-matched Regional Cohort | 278 | 139 | Open CABG: AF (23.4%), bleeding (2.2%), and mortality (8.3%). Minimally Invasive CABG: AF (20.1%), bleeding (2.2%), mortality (0.7%). | MICS-CABG accounted for a relatively minor proportion of the total number of CABGs conducted. MICS-CABG was linked to reduced durations of stay in the intensive care unit and hospital. | III |
Jia-Ji Liu [34] | China | Retrospective, single-center, observational | 0 | 118 | Minimally Invasive CABG: None. | Performing off-pump MICS CABG to treat multi-vessel disease entails a significant learning curve. The operating length, intraoperative blood loss, ICU admission, and postoperative inpatient duration may be prolonged. | III |
Hiroto Kitahara [35] | USA | Retrospective single-center | 0 | 57 | Minimally Invasive CABG: acute kidney injury (1.8%), AF (9.3%). | The process of selecting patients should incorporate a collaborative decision-making approach involving both robotic cardiac surgeons and interventional cardiologists. | III |
Yugal K. Mishra [36] | India | Retrospective cohort | 61 | 193 | Open approach in CABG: bleeding (3.4%), wound infection (2%), mortality (1.7%). Minimally Invasive CABG: bleeding (1%), wound infection (1.4%). | Using the da Vinci telemanipulation system in robotically enhanced telemanipulation surgery for MIDCAB. | III |
Sanin Fazlinović [37] | Sweden | Retrospective descriptive single-center cohort | 421 | 0 | Open CABG: hemorrhage (5.3%), acute renal failure (4.3%), acute respiratory failure (1%), wound infection (2.8%), mortality (2.3%). | The identification of acute surgeries as a risk factor for significant complications in the study underscores the importance of meticulous deliberation and prompt strategizing of surgical treatments, particularly in cases of acute nature. | III |
Ho Young Hwang [38] | USA | Retrospective | 601 | 300 | Open CABG: bleeding (4.3%). Minimally Invasive CABG: None. | The functional importance of coronary stenosis was linked to the rates of occlusion in bypass grafts that were connected to the coronary artery five years after surgery. | III |
Wenhui Gong [39] | China | Retrospective | 71 | 61 | Open CABG: wound infection (4%), MI (2%), mortality (5%). Minimally Invasive CABG: wound infection (1%), MI (3%), mortality (3%). | The RACAB grafts might be a good alternative for people who need a single or simple multi-vessel CABG. | III |
Carlo Antona [40] | Italy | Preoperative study | 0 | 41 | Minimally Invasive CABG: AF (4.8%), bleeding (2%). | MIDCABG, when administered to certain individuals, exhibits reliability, safety, and promising clinical outcomes in the early and mid-term. | III |
Lin Liang [41] | China | Retrospective cohort study | 398 | 281 | Open CABG: mortality (4%). Minimally Invasive CABG: MI (0.4%), mortality (2.5%). | The rates of MACCEs, such as cardiac death, MI, or recurrent revascularization, were not significantly different between CAD patients treated with MICS or CABG. | III |
Zia K [42] | Pakistan | Retrospective observational study | 70 | 30 | Open CABG: renal dysfunction (1%), mortality (0.4%). Minimally Invasive CABG: renal dysfunction (2.1%). | The selection between open and minimally invasive techniques in CABG should be tailored to the individual patient, considering patient-specific features, anatomical considerations, and clinical characteristics. | III |
Anno Diegeler [43] | Italy | Randomized controlled trials | 0 | 209 | Minimally Invasive CABG: graft failure (1.4%), bleeding (1.4%), MI (1.9%), mortality (0.4%). | MIDCAB is a very good way to revascularize the arteries in people with symptomatic left anterior descending coronary artery disease. | I |
Paweł Bugajski [44] | Poland | Retrospective Cohort | 211 | 0 | Open CABG: recurrent angina (12%), mortality (4%). | Patients with a higher number of grafts have more time-consuming CABG procedures. These entities exhibit elevated rates of long-term mortality while maintaining comparable levels of graft patency, in-hospital mortality, and morbidity. | II |
Redoy Ranjan [45] | London | Retrospective Cohort | 34 | 34 | Open CABG: bleeding (3.2%). Minimally Invasive CABG: None. | The reliability and effectiveness of CABG surgery with an endarterectomy have been established. The procedure successfully achieves the desired surgical myocardial revascularization in people with diffuse calcified CAD who do not have any other options for achieving sufficient myocardial revascularization. | III |
Marek Cisowskia [46] | Poland | Retrospective study | 0 | 50 | Minimally Invasive CABG: bleeding (4.5%). | In the context of selected individuals with double-vessel CAD, hybrid procedures have been identified as both safe and successful approaches for achieving full revascularization. | III |
Husam H. Balkhy [47] | Chicago | Retrospective Cohort | 544 | 0 | Open CABG: mortality (7.6%). | The robotic beating-heart TECAB is now thought to be safe and effective, with good results and similar early angiographic patency to traditional CABG surgery when performed regularly by a skilled team. | III |
BH Kirmani [48] | UK | Retrospective cohort | 6498 | 1029 | Open CABG: AF (1.9%), cardiac arrest (4.7%), mortality (1.2%). Minimally Invasive CABG: AF (2.3%), cardiac arrest (2%), mortality (0.4%). | The endoscopic harvesting of saphenous veins for CABG has the same quality as open vein harvesting when it comes to long-term survival. | III |
Ali İhsan Tekin [49] | Turkey | Retrospective cohort | 24 | 23 | Open CABG: None. Minimally Invasive CABG: None. | The MIDCAB technique works better than the OPCAB technique in the first few days of treatment in hospitals for patients with a serious LAD lesion. | III |
Minoru Ono [50] | USA | Retrospective cohort | 60 | 0 | Open CABG: deterioration of renal function (7%), wound infection (3%), bleeding (2%), stroke (2%), mortality (5%). | Patients with functional abdominal transplants can achieve satisfactory short- and long-term outcomes with the implementation of open-heart surgery. Select patients may not require a stress-dose steroid. | III |
Lufeng Zhang [51] | China | Retrospective cohort | 355 | 300 | Open CABG: None. Minimally Invasive CABG: bleeding (2%), mortality (0.3%). | The adoption of a chest wall lifting device and a redesigned stabilizer enhances the safety and ease of the MIDCAB technique. The feasibility and minimum invasiveness of the MIDCAB technique have been established as a viable alternative for individuals diagnosed with CAD. | II |
Hideaki Takai [52] | Japan | Retrospective cohort study | 43 | 0 | Open CABG: arrhythmia (0.2%). | After an acute MI, OPCAB can be performed as a relatively low-risk procedure with a good death rate, even up to 14 days after the MI. | III |
R Birla [53] | UK | Retrospective cohort | 78 | 74 | Open CABG: AF (1.2%), bleeding (1.3%), wound infection (2%), recurrent angina (5.1%), mortality (6.4%). Minimally Invasive CABG: AF (1.7%), bleeding (1%), wound infection (4%), recurrent angina (1.4%), mortality (1.4%). | The study revealed prospective advantages of MIDCAB, such as decreased hospitalization duration, diminished requirement for blood transfusions, and expedited recuperation. | III |
Joseph T. McGinn [54] | Canada | Retrospective cohort | 0 | 450 | Minimally Invasive CABG: pleural effusion (4.1%), pneumothorax (1.4%), wound infection (1%), mortality (1.1%). | MICS CABG is a safe and effective alternative to open CABG, with promising short-term outcomes and the potential to expand access to minimally invasive heart surgery. | III |
Emad A. Barsouma [55] | USA | Retrospective study | 98 | 61 | Open CABG: mortality (47.6%). Minimally Invasive CABG: mortality (19.7%). | MICS-CABG has a statistically significantly higher long-term survival rate than sternotomy-CABG in older people, even though the two procedures had some minor differences at the start. | III |
G.W. Stone [56] | Poland | Randomized controlled trials | 957 | 948 | Open CABG: MI (8.3%), mortality (5.9%). Minimally Invasive CABG: MI (0.8%). | Using fluoropolymer-based cobalt-chromium everolimus-eluting stents for PCI could be a good alternative to CABG for people with left main CAD whose anatomy is not very complicated. | I |
A. Diegelera [57] | Germany | Prospective study | 0 | 271 | Minimally Invasive CABG: MI (2.2%), bleeding (4.5%). | It is important to include post-operative angiographic control as part of the treatment following MIDCAB-grafting. | II |
Dong Li [58] | China | Retrospective Cohort | 128 | 32 | Open CABG: MI (1.6%), mortality (1.6%). Minimally Invasive CABG: None. | The treatment options for diffuse CAD include coronary artery reconstruction and surgical patch angioplasty of the coronary artery. There was no significant difference in patient outcomes. | III |
Lokeswara Rao Sajja [59] | India | Randomized controlled trials | 320 | 0 | Open CABG: mortality (1.8%). | There was no statistically significant difference between the off-pump and on-pump CABG groups in the overall rates of graft patency at 3 months when the surgery was performed by skilled surgeons who are more likely to use the off-pump method. | I |
Do-Kyun Kim [60] | South Korea | Retrospective Cohort | 104 | 0 | Open CABG: MI (1.9%), mortality (17.3%). | Although the surgical death rate following urgent CABG is greater at 17.3%, a positive long-term clinical outcome can be anticipated in the event of patient survival. | III |
Gursel Levent Oktar [61] | Turkey | Retrospective Cohort | 737 | 0 | Open CABG: AF (16.6%), mortality (0.1%). | Coronary artery surgery can be conducted in elderly patients with a tolerable level of risk. | III |
Arani Raghavendra [62] | India | Prospective cohort | 118 | 0 | Open CABG: bleeding (6.3%). | Healthcare professionals should consider the option of on-pump CABG in cases where the preservation of graft patency is a significant issue, particularly in individuals aged 70 years and above. | II |
Duk-Woo Park [63] | Korea | Retrospective Observational Cohort | 1138 | 1102 | Open CABG: MI (1.0%), mortality (0.5%). Minimally Invasive CABG: MI (8.1%), mortality (0.3%). | Patients with severe left main coronary artery (LMCA) disease can achieve revascularization through either PCI or CABG. Clinicians must consider each patient’s unique traits, preferences, and anatomical variables when deciding on the most suitable technique. | III |
Issam Moussa [64] | USA | Randomized controlled trials | 0 | 365 | Minimally Invasive CABG: ventricular arrhythmia (2.3%), respiratory failure (1.7%), MI (0.6%), mortality (3.1%). | Using the MIDCAB method has led to better operator skills and stabilizing technology, which has improved the patency rate of bypass grafts. | I |
Michael E. Halkos [65] | USA | Prospective cohort | 0 | 307 | Minimally Invasive CABG: stroke (0.3%), bleeding (2.3%), MI (1.6%), AF (15.3%), wound infection (2%), renal failure (2%), mortality (1.3%). | Robotic-assisted CABG is not recommended for hemodynamically unstable people who have intra-aortic balloon pumps or are having an MI that is becoming worse. There were relative contraindications for patients with a distal target vessel that was not working well or at all, who had a previous sternotomy or thoracotomy, who had a body mass index (BMI) of 40 or more, or who had a serious lung disease that made it impossible for them to maintain single-lung ventilation. | II |
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Alsharif, A.; Alsharif, A.; Alshamrani, G.; Abu Alsoud, A.; Abdullah, R.; Aljohani, S.; Alahmadi, H.; Fuadah, S.; Mohammed, A.; Hassan, F.E. Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review. Clin. Pract. 2024, 14, 1842-1868. https://doi.org/10.3390/clinpract14050147
Alsharif A, Alsharif A, Alshamrani G, Abu Alsoud A, Abdullah R, Aljohani S, Alahmadi H, Fuadah S, Mohammed A, Hassan FE. Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review. Clinics and Practice. 2024; 14(5):1842-1868. https://doi.org/10.3390/clinpract14050147
Chicago/Turabian StyleAlsharif, Arwa, Abdulaziz Alsharif, Ghadah Alshamrani, Abdulhameed Abu Alsoud, Rowaida Abdullah, Sarah Aljohani, Hawazen Alahmadi, Samratul Fuadah, Atheer Mohammed, and Fatma E. Hassan. 2024. "Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review" Clinics and Practice 14, no. 5: 1842-1868. https://doi.org/10.3390/clinpract14050147