Sex-related differences in conduit strategy and early outcomes after sternum-sparing on-pump multivessel CABG via left anterior thoracotomy

Background Sex-related disparities after conventional coronary artery bypass grafting (CABG) have been consistently reported, including differences in baseline risk profile, conduit strategy, and early adverse events. However, data on outcomes after sternum-sparing minimally invasive multivessel CABG remain limited. This study aimed to evaluate sex-related differences in baseline characteristics, operative strategy, and in-hospital outcomes in patients undergoing minimally invasive multivessel CABG using total coronary revascularization via left anterior thoracotomy (TCRAT). Methods From November 2019 to December 2025, CABG via left anterior minithoracotomy with cardioplegic arrest was the preferred surgical approach in our institution. The analysis included 807 men and 138 women undergoing non-emergency TCRAT. Baseline characteristics, grafting strategy, procedural times, and in-hospital outcomes, including mortality, stroke, myocardial infarction, repeat revascularization, and MACCE, were compared between sexes. Results Women were older (69.2 ± 8.9 vs. 66.7 ± 9.4 years, p = 0.004) and had a higher EuroSCORE II (3.85 ± 4.70 vs. 2.71 ± 2.51, p = 0.006). The extent of coronary artery disease was similar between sexes, with no significant difference in the distribution of 3-vessel and 2-vessel disease. Diabetes mellitus was more prevalent in women (44.2% vs. 34.0%, p = 0.026). Total arterial grafting (35.8% vs. 21.7%, p < 0.001) and radial artery use (62.2% vs. 35.5%, p < 0.001) were more frequent in men, who also received more distal anastomoses (3.17 ± 0.84 vs. 2.92 ± 0.90, p = 0.002). Operative, cardiopulmonary bypass, and cross-clamp times were also longer in men. In-hospital mortality (1.12% vs. 0.72%, p = 0.676), stroke (0.74% vs. 1.45%, p = 0.404), and MACCE (1.87% vs. 3.62%, p = 0.293) did not differ significantly between sexes. Conclusion Sternum-sparing multivessel CABG via left anterior thoracotomy was associated with similar early postoperative outcomes in men and women despite differences in baseline characteristics and conduit selection. Given the observational design and low event rates, these findings should be interpreted with appropriate caution.