The goal of this single-center prospective cohort study is to compare perioperative safety metrics and follow-up survival analyses in patients receiving Minimally Invasive Cardiac Surgery Coronary Artery Bypass Grafting(MICS-CABG) and Off-Pump Coronary Artery Bypass(OPCAB). The main question it aims to answer is:
Is the bridge vessel patency rate of patients in the MICS-Notouch group noninferior to that of a saphenous vein bridge with conventional open-chest bypass?
Participants will be divided into two groups:
Exposure group (MICS-Notouch group): non-extracorporeal circulation multiple coronary artery bypass grafting surgery performed under direct visualization of a small incision in the left chest, including the application of LIMA (left internal mammary artery) + SVG (saphenous vein) multiple bypass grafting.
Control group (OPCAB group): conventional median chest opening, non-extracorporeal circulation multi-branch coronary artery bypass graft surgery.
Patients with angina pectoris who experience functional limitations in daily life and work despite conservative medical treatment and who require coronary artery bypass grafting surgery, as confirmed by coronary angiography, are eligible for enrollment.
Patients with calcification of the ascending aorta, as confirmed by CT, who are not suitable for sidewall clamping are also eligible for enrollment.
The patient presents with an old, large myocardial infarction with no surviving myocardium, as evidenced by both isotope and echocardiographic imaging. This is a group of patients who are prone to complications, including significant cardiac enlargement, a cardiothoracic ratio greater than 0.75, an ejection fraction (EF) less than 30%, a left ventricular diameter (LVDd) greater than 70mm, the presence of a left ventricular ventricular wall tumor, or severe arrhythmia. Intraoperative hemodynamic instability;
Valve surgery or other intracardiac surgery at the same time;
Patients expected to undergo extracorporeal circulation surgery;
Poor myocardial infarction conditions, extensive lesions, distal or full diffuse stenosis, or lumen diameter less than or severe calcification that cannot be anastomosed.
Patients to undergo coronary artery bypass grafting due to coronary heart disease.
Cohort
Cross-sectional
Non-extracorporeal multiple coronary artery bypass graft (CABG) performed under direct visualization through a small incision in the left side of the chest.
Procedure/SurgeryExposure group (MICS-Notouch group): Direct visualization non-extracorporeal coronary artery bypass grafting with a small left chest incision, including the use of LIMA (left internal mammary artery) + SVG (saphenous vein) multibranch bypass grafting.
Multi-branch coronary artery bypass grafting with conventional median open heart and off-pump circulation
Procedure/SurgeryControl Group (OPCAB Group): Conventional median open multiple coronary artery bypass grafting with extracorporeal circulation.
Early Postoperative Saphenous Vein Bridge Vessel Patency Rate
The patients' bridge vessel patency is assessed by angiography within 1-14 days after surgery.
Early Postoperative Saphenous Vein Bridge Vessel Patency Rate
The patients' bridge vessel patency is assessed by Coronary Computed Tomography Angiography within 1-14 days after surgery.
Perioperative Safety Indicators
The following variables were considered: transfusion volume, extracorporeal circulation transfer rate, IABP and ECMO utilization rate, reoperation rate, incidence of poor wound healing, 1-year postoperative bridging vessel patency rate (CT or angiography), incidence of perioperative MACCE, incidence of atrial fibrillation, incidence of renal failure, incidence of re-tracheal intubation, duration of postoperative hospitalization, duration of ICU stay, duration of mechanical ventilation, and hospitalization costs.
Survival Analysis
The occurrence of MACCE (including all-cause mortality, re-bypass or stenting, acute infarction, and stroke), as well as readmission for infarction or heart failure at 1, 3, 6, and 12 months postoperatively, will be monitored.
Click on the lead sponsor to view all of their trials.
