Nonsternotomy Multivessel Coronary Surgery: Early and Midterm Results of Total Coronary Revascularization via Left Anterior Thoracotomy (TCRAT)

Background: Recently, a novel concept of minimally invasive total coronary revascularization avoiding sternotomy demonstrated promising hospital outcome in multivessel disease patients. However, follow-up data are still lacking. We present our early and midterm results after surgical coronary revascularization in unselected patients with the TCRAT-technique.

Method: From November 2019 to April 2022, CABG via left anterior minithoracotomy on cardiopulmonary bypass (peripheral cannulation) and cardioplegic cardiac arrest (transthoracic aortic cross-clamping) was successfully performed in 170 patients (147 males; 67.5 ± 9.6 [42–88] years). Another five patients were converted to sternotomy intraoperatively. All patients had multivessel coronary disease with indication to surgical revascularization (three-vessel: 75.3%; two-vessel: 22.9%; left main stenosis: 37.6%). We included patients at old age (>80 years: 13.5%), with severe left ventricular dysfunction (EF < 30%: 5.8%), massive obesity (BMI > 35: 8.8%), chronic lung disease (19.4%), and at increased risk (EuroSCORE II > 4: 17.6%). Mean follow-up was 11.2 ± 8.1 [0.2–26.9] months and was completed to 98.2%.

Results: Left internal thoracic artery (98.2%), radial artery (79,4%), and saphenous vein (47.1%) grafts were used for total (51.8%) or multiple (27.1%) arterial grafting in most cases. 3.2 (±0.7 [2–5] per patient) anastomoses were performed to revascularize the territories of left anterior descending (98.8%), circumflex (93.5%), and right (72.9%) coronary artery. Complete revascularization was achieved in 95.1%. Hospital mortality was 2.4%, stroke rate was 0.6%, and myocardial infarction rate was 1.2%. ICU stay was ≤1 day in 65.9% of patients, and 60% of patients left the hospital within 8 days after the operation. During the follow-up period, death from any cause was 2.4%, rate of cardiovascular death was 0.6%, myocardial infarction was 2.4%, repeat revascularization rate (PCI) was 4.2%, and cerebrovascular event rate was 0%.

Conclusion: Nonsternotomy multivessel coronary revascularization in unselected patients can be performed safely with similar to those of conventional CABG early and midterm results. Long-term results remain to be investigated.

Publication History

Article published online:
28 January 2023