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Ashenhurst et al. Vessel Plus 2024;8:3 https://dx.doi.org/10.20517/2574-1209.2023.90 Page 9 of 15

CABG and the OPCAB groups. A comparison of these cohorts found that the CABG cohorts had higher,
[42]
but statistically insignificant, rates of major adverse cardiac or cerebrovascular events .
A prospective, observational, comparative review by Baishya found that patients undergoing MICS CABG
generally have longer surgery durations, but a shorter period of ventilation use and less intraoperative blood
loss . Notably, MICS CABG patients receive few blood transfusions and have short ICU and hospital stays
[43]
[24]
on average , as outlined in Table 2.
Long-term outcomes
From its introduction in the 1960s, the durability of surgical revascularization has been well established in
the literature, although continued research on alternative, less invasive techniques must still be pursued .
[4]
Tables 3 and 4 summarize the results of studies following the midterm and long-term outcomes of MICS
CABG.

In 2018, a prospective study was conducted by McGinn and Ruel, studying the long-term outcomes in 800
patients who have undergone MICS CABG performed by two cardiac surgeons [44,45] . The LITA was
harvested in all the patients and a 4-6 cm thoracotomy in the left 5th intercostal space was used. The mean
follow-up for the patients was 2.2 years and a maximum of 6.4 years. This study showed that MICS CABG is
associated with a short hospital stay, no postoperative wound complications, and 6-year mortality rates
comparable to that of conventional CABG.

A recent prospective study conducted by Guo et al. investigated the 12-year survival, major adverse cardiac
and cerebrovascular events, revascularization, and function outcomes in an all-inclusive cohort from a
single center . A total of 566 patients who underwent MICS CABG were followed for survival. They were
[18]
then contacted for a questionnaire to assess their long-term functional outcomes. Clinical follow-up was
complete for 100% of the patients, and 83.9% (n = 427) of the alive patients were able to complete the
questionnaire. The study showed that at 12 years, the survival for the cohort was 82.2% ± 2.6% and freedom
from major adverse cardiac or cerebrovascular events (MACCE) was 75.5% ± 3.0% [Figure 6 and 7].

Functional outcomes
Guo et al. also reported functional outcomes to supplement and strengthen the investigated clinical
outcomes . Of the patients who completed the questionnaire, 12 (2.8%) had > CCS Class II angina and 19
[18]
(4.5%) reported having > NYHA Class II symptoms. Over 98% of patients indicated no pain at the incision
site. Cox proportional hazards analysis showed older age, peripheral vascular disease, prior MI, LV
dysfunction, cancer in the past 5 years, intraoperative transfusion, and hybrid revascularization to be
correlated with mortality during the follow-up period. This study further enforces MICS CABG as a reliable
and durable substitute to the conventional, more invasive sternotomy CABG for patients that match the
selection criteria.

Many advocates of minimally invasive surgeries indicate reduced hospital time and improved functional
outcomes earlier compared to traditional sternotomies. A recent multicenter randomized control trial by
Akowuah et al. compared the twelve-week functional outcome of patients who underwent a traditional
median sternotomy vs. mini-thoracotomy for a mitral valve repair surgery (MVr) . The study was unique
[46]
as it was an expertise-driven trial, requiring participating surgeons to have performed at least 50 of the
required procedures. Of the 1,167 screened patients, 330 were enrolled and randomized to the mini-
thoracotomy or sternotomy group. Investigators used the change in baseline 36-Item Short Form Health
Survey (SF-36) version 2 function T score to assess the functional outcomes of the two surgeries. The MICS