Cost-effectiveness of minimally invasive coronary artery bypass surgery

Background. Coronary artery bypass grafting without cardiopulmonary bypass is gaining popularity as an alternative to conventional on-pump technique f or myocardial revascularization. This includes minimally invasive direct co ronary artery bypass (MIDCAB) and full sternotomy off-pump (OPCAB) methods. These two approaches should be evaluated for financial and clinical approp riateness. Methods. Records of patients who had single or double bypass (internal mamm ary artery and/or saphenous vein) grafts between January 1997 and June 1998 were reviewed. These included 44 MIDCAB, 62 OPCAB, and 243 conventional co rollary artery bypass (CCAB) patients. Univariate analysis was applied to p re, intra, and postoperative variables, comparing MIDCAB and OPCAB to the C CAB group. Procedural cost information was obtained from participating inst itutions. Results. MIDCAB patients compared to CCAB patients had a higher predicted r isk (5.4 +/- 11 versus 2.3 +/- 2.8, p 0.012) and OPCAB patients had a predi cted risk of 5.3 +/- 7.8. MIDCAB and OPCAB procedures required less operati ng room time and blood utilization. Observed operative mortality rates were MIDCAB 4.5%, OPCAB 1.6%, and CCAB 2.8% (not significant). Mean hospital co sts were CCAB at $19,000, OPCAB at $15,000, and $17,000 for MIDCAB. Conclusions. Off pump procedures currently reflect acute episode-of-care co st savings over CCAB. (C) 1999 by The Society of Thoracic Surgeons.