Journal of thoracic disease · 2026
Ten-year survival, clinical durability, and physiological resilience of minimally invasive versus sternotomy coronary artery bypass grafting: propensity-matched analysis.
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Ding Tong, Fu Yuanhao, Song Jian, Li Rui, Yang Hang, Wang Xiaoxiao, Gong Yichen, Ling Yunpeng
Аннотация
BACKGROUND: Although early safety of minimally invasive coronary artery bypass grafting (MICS-CABG) is validated, concerns regarding long-term clinical durability and survival relative to conventional sternotomy persist. The study aims to evaluate 10-year survival and major adverse cardiac and cerebrovascular events (MACCE) of MICS-CABG.
METHODS: An ambispective cohort was assembled by retrospectively identifying consecutive patients who underwent isolated CABG between November 2015 and March 2019, with prospective follow-up initiated in 2020 under a standardized protocol. Propensity-score matching (1:1) yielded 244 pairs (n=488 total). The primary endpoint was 10-year survival. Secondary endpoints included MACCE (death, myocardial infarction, stroke, or repeat revascularization).
RESULTS: In the matched cohort (median follow-up, 93 months), MICS-CABG was associated with superior 10-year survival compared with sternotomy-CABG (85.9% vs. 66.9%; log-rank P<0.001). The 10-year MACCE rate reduced in the MICS-CABG group [26.2% vs. 43.6%; hazard ratio (HR): 0.60; 95% confidence interval (CI): 0.43-0.83; P=0.002]. Crucially, there was no significant difference in the incidences for stroke (8.0% vs. 14.5%; P=0.21), myocardial infarction (4.5% vs. 5.4%; P=0.51), or repeat revascularization (6.0% vs. 4.3%; P=0.52). Survival analysis revealed that the mortality benefit was driven primarily by attenuated non-cardiac mortality (8.2% vs. 19.1%; P<0.001).
CONCLUSIONS: MICS-CABG was associated with higher 10-year survival rate and reduced MACCE risk compared with sternotomy-CABG, without compromising long-term clinical durability. The survival benefit was predominantly driven by reduced non-cardiac mortality which suggest that sternal-sparing approach may preserve physiological reserve, thereby enhancing patient resilience against systemic stressors.
METHODS: An ambispective cohort was assembled by retrospectively identifying consecutive patients who underwent isolated CABG between November 2015 and March 2019, with prospective follow-up initiated in 2020 under a standardized protocol. Propensity-score matching (1:1) yielded 244 pairs (n=488 total). The primary endpoint was 10-year survival. Secondary endpoints included MACCE (death, myocardial infarction, stroke, or repeat revascularization).
RESULTS: In the matched cohort (median follow-up, 93 months), MICS-CABG was associated with superior 10-year survival compared with sternotomy-CABG (85.9% vs. 66.9%; log-rank P<0.001). The 10-year MACCE rate reduced in the MICS-CABG group [26.2% vs. 43.6%; hazard ratio (HR): 0.60; 95% confidence interval (CI): 0.43-0.83; P=0.002]. Crucially, there was no significant difference in the incidences for stroke (8.0% vs. 14.5%; P=0.21), myocardial infarction (4.5% vs. 5.4%; P=0.51), or repeat revascularization (6.0% vs. 4.3%; P=0.52). Survival analysis revealed that the mortality benefit was driven primarily by attenuated non-cardiac mortality (8.2% vs. 19.1%; P<0.001).
CONCLUSIONS: MICS-CABG was associated with higher 10-year survival rate and reduced MACCE risk compared with sternotomy-CABG, without compromising long-term clinical durability. The survival benefit was predominantly driven by reduced non-cardiac mortality which suggest that sternal-sparing approach may preserve physiological reserve, thereby enhancing patient resilience against systemic stressors.