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 for myocardial revascularization. This includes minimally invasive direct coronary artery bypass (MIDCAB) and full sternotomy off-pump (OPCAB) methods. These two approaches should be evaluated for financial and clinical appropriateness. Methods. Records of patients who had single or double bypass (internal mammary artery and/or saphenous vein) grafts between January 1997 and June 1998 were reviewed. These included 44 MIDCAB, 62 OPCAB, and 243 conventional corollary artery bypass (CCAB) patients. Univariate analysis was applied to pre, intra, and postoperative variables, comparing MIDCAB and OPCAB to the CCAB group. Procedural cost information was obtained from participating institutions. Results. MIDCAB patients compared to CCAB patients had a higher predicted risk (5.4 +/- 11 versus 2.3 +/- 2.8, p 0.012) and OPCAB patients had a predicted risk of 5.3 +/- 7.8. MIDCAB and OPCAB procedures required less operating room time and blood utilization. Observed operative mortality rates were MIDCAB 4.5%, OPCAB 1.6%, and CCAB 2.8% (not significant). Mean hospital costs were CCAB at $19,000, OPCAB at $15,000, and $17,000 for MIDCAB. Conclusions. Off pump procedures currently reflect acute episode-of-care cost savings over CCAB. (C) 1999 by The Society of Thoracic Surgeons.