EARLY AND MID-TERM RESULTS OF MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB) SURGERY

Background and 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, while secondary endpoints included early postoperative outcomes and 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 87.6% [81.3-94.7], 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, p=0.030) and postoperative atrial fibrillation (HR 3.405, 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 mid-term survival. These findings align with existing literature, underscoring the procedure’s reproducibility. Further multicenter studies are needed to validate these results and compare MIDCAB with other revascularization strategies.