Comparison of Off-Pump CABG and Multivessel MIDCAB: A Propensity Score-Matched Single-Center Analysis of Perioperative and Short-Term Outcomes

All articles of this category (opens in new window) Background: The optimal revascularization strategy for multivessel coronary artery disease remains a central challenge in cardiac surgery. This study compares the perioperative and short-term clinical outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) with the minimally invasive multivessel Direct Coronary Artery Bypass (MV-MIDCAB) technique to clarify their respective advantages and limitations. Methods: In a retrospective, single-center analysis, 620 consecutive patients (December 2021–February 2025) undergoing OPCAB ( n = 440) or MV-MIDCAB ( n = 180) were evaluated. Using propensity score matching (1:1), 118 patient pairs were formed to ensure comparable baseline characteristics. Primary endpoints included in-hospital mortality, stroke, and acute kidney injury (AKI). Secondary endpoints were completeness of revascularization, need for re-thoracotomy, and length of stay in the intensive care unit (ICU) and hospital. Results: After propensity score matching, both groups showed comparable demographics and comorbidities (age: 66 ± 9 years; EuroScore II: 1.8 ± 1.2 vs. 1.7 ± 1.7). The MV-MIDCAB group exhibited a significantly lower rate of complete revascularization (55.1% vs. 85.5%, p < 0.001) and demonstrated a higher utilization of the aorta-no-touch technique (100% vs. 78.0%, p < 0.001). The use of two internal thoracic artery (ITA) grafts was less frequent in the MV-MIDCAB group (19.5% vs. 65.8%, p < 0.001). Postoperatively, the incidence of AKI was significantly higher in the MV-MIDCAB group (5.1% vs. 0%, p = 0.029). No significant differences were found for stroke (0.8% vs. 0%), delirium (11.0% vs. 5.1%, p = 0.150), re-thoracotomy, or length of stay (ICU: 1.6 vs. 1.7 days, p = 0.498). In-hospital mortality was 0% in both groups. Conclusion: While MV-MIDCAB allows for complete aorta-no-touch revascularization, it is associated with reduced completeness of revascularization and an increased risk of acute kidney injury. OPCAB, conversely, offers a superior revascularization rate without a significant increase in morbidity or mortality. These findings underscore the necessity for careful patient selection and further prospective studies to evaluate the long-term outcomes of both procedures. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany