Surgical outcomes of EA-MIDCAB vs. full sternotomy CABG in multi-vessel coronary artery disease: a retrospective cohort study

BACKGROUND: Minimally invasive coronary artery bypass techniques are increasingly adopted to reduce surgical trauma and enhance recovery. This study aimed to compare early clinical outcomes of endoscopic-assisted minimally invasive direct coronary artery bypass (EA-MIDCAB)—predominantly via a periareolar incision—with conventional full sternotomy coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease. METHODS: We retrospectively analyzed 393 patients diagnosed with multivessel coronary artery disease who underwent coronary artery bypass grafting (CABG) between February 2021 and May 2025. Of these, 332 underwent endoscopic-assisted minimally invasive direct CABG (EA-MIDCAB), and 61 underwent conventional full sternotomy CABG. Baseline characteristics, intraoperative and postoperative outcomes, and complication rates were compared between groups. Statistical analyses were performed using appropriate tests, with significance defined as p < 0.05. RESULTS: Baseline characteristics and coronary stenosis distribution were comparable between groups. EA-MIDCAB patients demonstrated significantly lower cardiopulmonary bypass (CPB) usage (11.1% vs. 83.6%, p < 0.001), reduced red blood cell transfusion requirements (0.82 vs. 1.56 pints, p < 0.001), and fewer graft conduits (≥ 4 conduits: 0.6% vs. 19.2%, p < 0.001). Despite a higher prevalence of diabetes and hypertension, short-term outcomes—including mortality, renal dysfunction, and postoperative myocardial infarction—were similar between the two groups. CONCLUSIONS: EA-MIDCAB offers a safe and effective alternative to full sternotomy CABG for multivessel coronary artery disease, with reduced surgical trauma and transfusion needs.