Objective: To clarify the effect of the learning curve (LC) on minimally invasive direct coronary artery by-pass (MIDCAB) outcomes for the first time.
Methods: Patients who underwent MIDCAB were enrolled in this study. The patients’ characteristics were recorded prospectively. A 75 patients were divided into three groups, with the first 25 patients undergoing MIDCAB in group 1 and the last 25 patients undergoing MIDCAB in group 3.
Results: Comparison of the groups revealed that the operation time significantly decreased after 50 cases (p=0.003). Duration for access to the pericardium was similar between groups (p=0.094), but duration for preparing vessels progressively decreased from group 1 to group 3 (p=0.001). In addition, anastomosis duration significantly decreased in group 3 (p=0.005). In addition, the hospitalization time was significantly shorter in group 3 (p=0.018). The complication rate was significantly lower in group 3 and group 2 than in group 1 (p=0.030). Additionally, major cardiovascular and cerebrovascular events (MACCE) in the first postoperative year was detected in 20% of patients in group 1 and 8% of patients in group 2 and group 3, and the statistical difference was significantly better in favour of group 2 and group 3 (p=0.043).
Conclusion: The present study is the first to define the LC for MIDCAB, and we achieved significantly lower blood loss within 24 h after operation and lower complication rates after 25 cases, and perioperative transfusion rate, operation time, and hospitalization period were significantly decreased after 50 cases. Moreover, the number of MACCEs in the first postoperative year was significantly lower after 25 cases.