Effectiveness of MIDCAB vs. OPCAB in LAD revascularization procedures in octogenerians: Results from the KROK registry

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BACKGROUND: Despite a clear preference for transcatheter procedures over surgical ones in 80-year-olds, minimally invasive approaches for coronary artery bypass grafting offer a valuable alternative to conventional median sternotomy and on- or off-pump surgery. The clinical relevance of off-pump procedures continues to grow in the context of an aging population. However, comparative data between the minimally invasive direct coronary artery bypass (MIDCAB) and the off-pump coronary artery bypass (OPCAB) via sternotomy in octogenarians remain limited. AIMS: This study aimed at a retrospective comparison between the outcomes of MIDCAB and OPCABin patients aged >80 years with 1 vessel disease, using data from the Polish National Registry of Cardiac Surgery Procedures. METHODS: The analysis covered 1035 patients undergoing isolated single-vessel coronary artery bypass grafting with the left internal thoracic artery between 2006 and 2023. Among them, 296 underwent MIDCAB and 739 underwent OPCAB surgery. Propensity score matching yielded 237 well-balanced patients per group. Baseline characteristics, postoperative outcomes, and early and long-term survival were compared. Follow-up ranged from 0.1 to 12.8 years. RESULTS: No differences were observed in baseline characteristics or early and long-term mortality between the groups (24.9% in the MIDCAB group, 32.5% in the OPCAB group, P >0.084). The MIDCAB group was characterized by a shorter hospital stay (11.26 vs. 12.62 days; P = 0.004), a lower incidence of respiratory complications (0.8% vs. 4.2%; P = 0.041), and reduced prolonged mechanical ventilation (16.6% vs. 28.6%; P = 0.008). CONCLUSIONS: In octogenarians receiving the isolated left internal thoracic artery to LAD bypass, MIDCAB is as safe and effective as OPCAB. MIDCAB is associated with shorter hospitalization, fewer respiratory complications, and reduced prolonged postoperative ventilation.

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