Less-invasive coronary artery bypass grafting international landscape and progress.

Abstract

Less-invasive coronary artery bypass grafting (CABG) has evolved in multiple forms. Specifically noteworthy are recent technical refinement and reports of mid-term outcomes from well designed trials and observational studies in off-pump CABG, minimally invasive coronary artery bypass grafting (MICS CABG) and hybrid coronary revascularization (HCR). This review summarizes the historical evolution and recent development in less-invasive coronary artery bypass grafting. A recent network meta-analysis of CABG with various degree of aortic manipulation demonstrated that no-touch technique may result in a significant reduction of postoperative stroke risk. A 5-year follow-up data of CORONARY study demonstrated that there was no significant difference in the rate of mortality, repeat revascularization, or primary composite outcome. The first multicenter observational study of HCR and PCI cohorts demonstrated that there was no significant difference in major adverse cardiac and cerebrovascular events at 12 months, with diverging event-free survival favoring HCR toward the end of the study period. Less-invasive CABG continues to evolve in multiple forms. MICS CABG with the use of bilateral internal thoracic arteries preserves the sternum while allowing for a robust revascularization. HCR augments each form of less-invasive CABG, and is expected to play a larger role in the near future.