Hans Georg Borst Preis: Multi-Vessel Minimally Invasive vs. Sternotomy CABG: A Meta-Analysis of Early and Mid-Term Outcomes of Propensity-Matched Studies

All articles of this category (opens in new window) Background: Multi-vessel Minimally Invasive CABG (MICS) is gaining increasing popularity. This is the first meta-analysis of matched studies to report on early and mid-term outcomes of MICS vs. Sternotomy CABG (ST-CABG). Methods: We searched the literature up to July 2025 to identify studies comparing MICS-CABG to ST-CABG. Only propensity-score matched studies in which all patients received at least two distal anastomoses were included. We performed both pairwise and reconstructed time-to-event meta-analyses to evaluate early and mid-term outcomes. Results: We included six matched studies published between 2022 and 2025, comprising a total of 1,866 patients (933 MICS vs. 933 ST-CABG). The majority of patients were males, with similar frequencies in both groups (81%). The mean number of anastomoses was significantly lower in the MICS group (MD: −0.44 [−0.57; −0.32], p < 0.001). There was a trend toward shorter hospital stay (MD: −0.64 days [−1.50, 0.21], p = 0.14) and lower transfusion rates (20.6% vs. 27.6%, p = 0.08) in the MICS group. No significant differences were observed in in-hospital mortality (0.8% vs. 1.4%, p = 0.20), re-thoracotomy (3.9% vs. 2.6%, p = 0.14), or complete anatomical revascularization (94.6% vs. 96.6%, p = 0.23). Mid-term outcomes from pooled analyses of three studies showed no differences in 5-year survival (HR = 1.09 [95% CI: 0.70–1.69], p = 0.70) or MACCE incidence (HR = 1.17 [95% CI: 0.83–1.66], p = 0.37). Conclusion: Overall, MICS-CABG appears as safe as ST-CABG, with potential advantages of earlier recovery and lower transfusions, while mid-term outcomes remain comparable. Nonetheless, caution regarding incomplete revascularization is warranted, and further validation and careful patient selection are essential. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany