Recent clinical effect of minimally invasive coronary artery bypass grafting in elderly patients with complex coronary heart disease and heart failure with reduced ejection fraction
ZHAO Qiancong
TANG Jiayou
WEN Changnuan
LI Zhihang
LIU Jincheng
Abstract：Objective To investigate the clinical safety and effectiveness of minimally invasive coronary artery bypass grafting(MICS-CABG)via the left intercostal approach in elderly patients(＞70 years old)with complex coronary heart disease and reduced ejection fraction(EF＜40％).Methods The clinical data of 60 patients＞70 years old with a preoperative left ventricular EF＜40％who underwent coronary artery bypass grafting in the Department of Cardiac Surgery,Xijing Hospital,Air Force Medical University from April 2022 to October 2024 were analyzed.These patients were divided into two groups:the median sternotomy group(OP-CABG group)with 30 patients and the MICS-CABG group with 30 patients.Based on matched baseline information,a retrospective analysis was conducted to compare the perioperative data and one-year follow-up results between the two groups.Results There was no significant difference in baseline levels between the MICS-CABG group and the OP-CABG group.The MICS-CABG group had shorter operative duration,less intraoperative blood loss,lower perioperative blood transfusion rate,shorter postoperative ventilator assistance time,less postoperative drainage volume,and lower incidence of postoperative pleural effusion and wound complications(all P＜0.05).One-year follow-up after surgery showed that there was no significant difference in the patency rate of bridge vessels,improvement of EF values,MACCE events,and incidence of chronic wound pain between the two groups of patients.However,the MICS-CABG group had lower incidence of complications of poor wound healing compared to the OP-CABG group(P＜0.05).Conclusion Although MICS-CABG technology is difficult and has a long learning curve,its application in elderly patients with complex coronary heart disease and heart failure with reduced EF values can effectively shorten the operative time,reduce intraoperative bleeding,postoperative drainage,and transfusion rate.Compared with conventional open chest surgery,it is more acceptable for patients.One-year follow-up after surgery shows that the improvement of EF values and patency rate of bridge vessels in the MICS-CABG group are similar to those in the OP-CABG group,and effectively avoid complications of poor wound healing.
Keywords：complex coronary heart diseaseminimally invasive coronary artery bypass graftingadvanced ageheart failure with reduced EFoff-pump coronary artery bypass graftingleft internal mammary arterygreat saphenous veinmajor adverse cardiac and cerebrovascul
Publication Date：2025-09-30
Online Publishing Date：2026-08-26(First online date of this platform, not the publication date of the document)
Pages：6( 1127-1132 )