[Efficacy and safety between minimally invasive left intercostal small incision and median sternotomy coronary artery bypass grafting inmulti-vessel coronary disease patients with concomitant diabetes].

Objective: To compare the efficacy and safety of thoracoscopic-assisted left intercostal small incision and median sternotomy coronary artery bypass grafting (CABG) in the treatment of multi-vesselcoronary disease patients with concomitant type 2 diabetes mellitus (T2DM). Methods: The clinical data of multi-vessel coronary disease patients with concomitant T2DM who were admitted to Fuwai Huazhong Cardiovascular Hospital from January 2020 to January 2024 were retrospectively collected. According to the treatment regimen, patients who underwent minimally invasive left intercostal small incision CABG were included in the minimally invasive group, and patients who underwent median sternotomy CABG were included in the traditional group. The perioperative indicators, intraoperative bypass grafts, and the incidence of major adverse cardiac and cerebrovascular events (MACCE) at 1 year after operation were compared between the two groups. Results: After propensity score matching, there were 51 patients in the minimally invasive group, including 28 males and 23 females, with an average age of (62.6±2.1) years. There were 51 patients in the traditional group, including 31 males and 20 females, with an average age of (63.2±2.7) years. No statistically significant differences were detected in age, gender, body mass index, preoperative fasting blood glucose, glycosylated hemoglobin, comorbidities, smoking history, previous myocardial infarction history, left ventricular ejection fraction, SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score, and duration of diabetes between the two groups (all P>0.05). The operation time in the minimally invasive group was longer than that of the traditional group [(245.3±35.1) min vs (215.7±28.4) min]. However, the postoperative mechanical ventilation time [(10.2±2.3) h vs (14.8±3.2) h], length of intensive care unit (ICU) stay [(25.3±4.1) h vs (28.4±6.3) h], and hospitalization time [(7.8±1.5) d vs (10.9±2.4) d] were shorter in the minimally invasive group than in the traditional group (all P<0.05). The perioperative blood transfusion rate [9.8% (5/51) vs 31.4% (16/51)] and the incidence of complications [7.8% (4/51) vs 37.3% (19/51)] were lower than those in the traditional group (all P<0.05). No significant differences were observed between the two groups in the mean blood flow and pulsatility index of all bypass grafts [(35.2±8.7) ml/min vs (36.1±9.2) ml/min; 2.4±0.6 vs 2.3±0.5], the left internal mammary artery (LIMA) [(28.1±6.8) ml/min vs (27.8±7.1) ml/min; 1.9±0.5 vs 2.0±0.5], or the great saphenous vein [(45.6±10.3) ml/min vs (46.7±11.0) ml/min; 2.8±0.7 vs 2.7±0.6] (all P>0.05). The total incidence of MACCE at 1 year after operation in the minimally invasive group was 5.9% (3/51), which was not significantly different from that in the traditional group [9.8% (5/51)] (P=0.475). Conclusions: Compared with median sternotomy CABG, thoracoscopic-assisted left intercostal small incision CABG has a lower proportion of postoperative blood transfusion and a shorter recovery process in the treatment of multi-vessel coronary artery disease patients with concomitant T2DM. The incidence of MACCE is similar between the two procedures at 1 year after surgery.