Minimally Invasive Total Arterial Bypass Grafting via Left Mini-thoracotomy in Obese Patients

Abstract

Background

Minimally invasive cardiac surgery total arterial coronary artery bypass grafting (MICS-CABG) has emerged as an alternative to conventional coronary artery bypass grafting (CABG). Its safety and efficacy in obese patients remain a concern due to technical challenges. The current study compares early and long-term outcomes of MICS-CABG in obese and non-obese patients.

Methods

Between January 2015 and December 2023, 279 patients underwent off-pump MICS-CABG at our center. Obesity was defined as body mass index ≥30 (kg/m²). The primary endpoint was 30-day survival. Secondary endpoints were survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) at 5 years.

Results

Of all 279 patients, 56 (20.1%) were classified as obese and 223 (79.9%) as non-obese. Obese patients had a higher EuroSCORE II (2.06 ± 1.53 vs. 1.63 ± 0.94, p = 0.008) and a higher prevalence of comorbidities including diabetes mellitus (p < 0.001) and pulmonary hypertension (p = 0.03). The incidence of postoperative complications including repeat thoracotomy for bleeding (p = 0.18), low cardiac output syndrome (p = 0.70), or wound infection (p = 0.38) did not differ between obese and non-obese patients. There were no deaths or myocardial infarctions within 30 days in obese patients (0% vs. 0.5%, p = 0.95; 0% vs. 2.7%, p = 0.47). Long-term outcome at 5 years, including survival (91.9% vs. 92.4%, p = 0.99) and freedom from MACCE (83.3% vs. 84.6%, p = 0.63), showed no difference between the two groups.

Conclusion

MICS-CABG can be performed safely and efficaciously in select obese patients by specialized coronary surgeons at high-volume cardiac centers.

Keywords

minimally invasive surgery (includes port access mini-thoracotomy) - coronary artery bypass grafts surgery - CABG - obesity

Authors' Contribution

I.G. played a significant role in study conception and design, data collection, manuscript drafting, and took responsibility for the accuracy and integrity of all aspects of the research; R.S. contributed significantly to study conception and design, data collection, and manuscript drafting; J.K. conducted the statistical analysis; A.D., J.E., W.Z., and S.d.W. contributed to revising the manuscript; M.B. approved the final version of the manuscript for publication; A.V. contributed to manuscript drafting and approved the final version for publication.

^* These authors contributed equally as first authors.

Publication History

Received: 25 February 2025

Accepted: 28 July 2025

Accepted Manuscript online:
30 July 2025

Article published online:
21 August 2025

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