Starting of Minimally Invasive Coronary Artery Bypass Grafting—Actuality in a Single Center

Background: Minimally invasive direct coronary artery bypass (MIDCAB) through mini left thoracotomy has been performed for revascularization of the left anterior descending artery (LAD) mainly using the left internal thoracic artery (LITA), even as a hybrid concept with planned percutaneous coronary intervention (PCI) of other coronary arteries. However, the reality and pitfall about the safe introduction of this technically challenging operation into an institution has not been widely discussed.

Methods: The routine adoption of this procedure was started in our institution in August 2022, and 79 consecutive cases of non-robotic MIDCAB in a single center between August 2022 and March 2024 were enrolled. Indication of MIDCAB were discussed and decided in heart team conference, and LITA were harvested through left mini thoracotomy in a skeletonized fashion. The outcome was retrospectively summarized and analyzed. To investigate the impact of initial learning status further, the outcome of the first half (n = 40) and latter half (n = 39) of the cases were retrospectively compared.

Results: 68 patients (86.1%) were male and mean age was 67.4 ± 9.2 years old. Mean EuroScore II was 1.5 ± 1.3. Mean left ventricular ejection fraction (LVEF) was 53.2 ± 10.2%, and 10 cases (12.7%) had low EF (<40%). Six patients (7.6%) received additional anastomoses (≥2 grafts). Planned preoperative or postoperative PCI (as a hybrid therapy) were performed in 23 (29.1%) cases. Mean operation time was 195.9 ± 54.4 minutes, and mean duration of ICU stay was 1.7 ± 2.4 days. Four cases (5.1%) needed conversion to sternotomy (LITA dissection: n = 1; difficult operative field: n = 2; insufficient LITA-LAD flow: n = 1), and re-intervention was performed in 3 cases due to obstructed graft flow (3.8%) (re-MIDCAB using saphenous vein: n = 1; re-bypass via sternotomy: n = 2). There was no in-hospital death. There was no significant difference in outcome between the cases in first half and those in latter half, but all MACCE (n = 4) occurred in the first half period.

Conclusion: Implementation of routine MIDCAB in our institute was safely achieved with no mortality, though MACCE likely occurred in the early cases. MIDCAB could be started as a feasible option also for patients with multiple vessel diseases in the concept of hybrid therapy under adequate selection of the cases.

Publication History

Article published online:
11 February 2025