Postoperative Outcomes of Minimally Invasive Versus Conventional Off-Pump Coronary Artery Bypass Within an ERACS Protocol - Matched Analysis

Q: What is the main clinical question of the study?

Whether a standardized ERACS protocol with early extubation and routine ICU bypass can produce comparable short-term recovery outcomes between MICS-CABG and OPCAB.

Q: How were patients selected and how were groups balanced?

This single-center retrospective study included adult patients treated between January 2020 and December 2024, with propensity score matching applied 1:1 using key demographic and clinical variables.

Q: Which outcomes were considered primary and secondary?

Primary outcomes were hospital length of stay, ventilation time, and unplanned ICU transfer. Secondary outcomes included postoperative complications, transfusion needs, pain scores, and in-hospital mortality.

Sep 30, 2026

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Minimally invasive coronary artery bypass grafting (MICS-CABG) may reduce access-related trauma compared with conventional off-pump coronary artery bypass (OPCAB), yet it can impose more demanding surgical and anesthetic requirements. This single-center retrospective matched analysis assessed whether a standardized ERACS pathway with early extubation in PACU and routine ICU bypass can yield comparable short-term recovery between approaches. Adult patients treated from January 2020 to December 2024 were propensity score matched 1:1, evaluating length of stay, ventilation time, ICU transfer, complications, transfusion, pain, and in-hospital mortality.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Minimally invasive CABG development

Fast-track and ERAS principles in cardiac surgery

Differences between MICS-CABG and OPCAB

Study aim and hypothesis

Article Postoperative Outcomes of Minimally Invasive Versus Conventional Off-Pump Coronary Artery Bypass Within an ERACS Protocol: A Matched Analysis Mostafa Saad 1,†, Ibrahim Gadelkarim 2,†, Michael Borger 2, Massimiliano Meineri 1, Aniruddha Janai 1, Sophia Sgouropoulou 1, Jörg Ender 1 and Waseem Zakhary 1, * Academic Editors: Parwis Massoudy and Hilmar C. Dörge Received: 30 November 2025 Revised: 25 December 2025 Accepted: 29 December 2025 Published: 1 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Anaesthesia and Intensive Care Medicine, Leipzig Heart Center, 04289 Leipzig, Germany; [mostafa.saad@helios-gesundheit.de](mostafa.saad@helios-gesundheit.de) (M.S.); [massimiliano.meineri@helios-gesundheit.de](massimiliano.meineri@helios-gesundheit.de) (M.M.); [aniruddha.janai@helios-gesundheit.de](aniruddha.janai@helios-gesundheit.de) (A.J.); [sophia.sgouropoulou@helios-gesundheit.de](sophia.sgouropoulou@helios-gesundheit.de) (S.S.); joerg.ender@helios-gesundheit.de (J.E.) 2 Department of Cardiac Surgery, Leipzig Heart Center, 04289 Leipzig, Germany; ibrahim.gadelkarim@helios-gesundheit.de (I.G.); [michael.borger@helios-gesundheit.de](michael.borger@helios-gesundheit.de) (M.B.) * Correspondence: waseemzakariaaziz.zakhary@medizin.uni-leipzig.de or [waseemzakariaaziz.zakhary@helios-gesundheit.de](waseemzakariaaziz.zakhary@helios-gesundheit.de)[ ](waseemzakariaaziz.zakhary@helios-gesundheit.de)† These authors contributed equally to this work. Abstract Background/Objectives: Minimally invasive coronary artery bypass grafting (MICS-CABG) offers reduced access trauma compared with conventional off-pump coronary artery bypass (OPCAB) but requires more demanding surgical and anesthetic conditions, including single-lung ventilation. Enhanced Recovery After Cardiac Surgery (ERACS) pathways—particularly those incorporating early extubation in a post-anesthesia care unit (PACU) and routine ICU bypass—may harmonize postoperative recovery across different surgical approaches. This study evaluated whether a standardized early-extubation ERACS protocol could achieve comparable short-term recovery outcomes between MICS-CABG and OPCAB. Methods: This single-center retrospective study included all adult patients who underwent off-pump MICS-CABG via mini-thoracotomy or OPCAB via sternotomy between January 2020 and December 2024 within an ERACS pathway. Propensity score matching (1:1) was applied using key demographic and clinical variables. Primary outcomes were hospital length of stay (LOS), ventilation time, and unplanned ICU transfer. Secondary outcomes included postoperative complications, transfusion requirements, pain scores, and in-hospital mortality. Results: Of 144 MICS-CABG patients, 131 met inclusion criteria and 116 were propensity-matched to 116 OPCAB patients. Operative duration was longer in MICS-CABG (238.9 ± 65 vs. 175.0 ± 48 min; p < 0.001) . However, ventilation time (112.2 ± 56.9 vs. 116.9 ± 64.7 min; p = 0.59), hospital LOS (8.7 ± 4.0 vs. 8.6 ± 4.1 days; p = 0.78), and unplanned ICU transfer (0.9% vs. 2.6%; p = 0.37) were comparable. Postoperative complications, transfusion rates, pain scores, and in-hospital mortality also did not differ significantly. Conclusions: Within a structured ERACS pathway incorporating early extubation and ICU bypass, MICS-CABG and OPCAB achieved similar short-term recovery outcomes despite differences in operative complexity. These findings suggest that ERACS can provide a consistent postoperative recovery framework across both revascularization strategies. Keywords: MICS-CABG; OPCAB; ERACS; early extubation; minimally invasive cardiac surgery; postoperative recovery 1. Introduction Minimally invasive surgery emerged in general surgery in the late 1980s, when the first video-ass

FAQs

What is the main clinical question of the study?

Whether a standardized ERACS protocol with early extubation and routine ICU bypass can produce comparable short-term recovery outcomes between MICS-CABG and OPCAB.

How were patients selected and how were groups balanced?

This single-center retrospective study included adult patients treated between January 2020 and December 2024, with propensity score matching applied 1:1 using key demographic and clinical variables.

Which outcomes were considered primary and secondary?

Primary outcomes were hospital length of stay, ventilation time, and unplanned ICU transfer. Secondary outcomes included postoperative complications, transfusion needs, pain scores, and in-hospital mortality.

Sep 30, 2026

Upload by jay