Evolution of Minimally Invasive Coronary Artery Bypass Grafting

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Minimally invasive coronary surgery approach for coronary artery bypass grafting is a safe and reproducible procedure for multivessel revascularization. This study reviewed a single surgeon's experience with minimally invasive coronary surgery coronary artery bypass grafting, including operative time, number of bypasses, and conversion to sternotomy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A prospective database of consecutive minimally invasive coronary surgery coronary artery bypass grafting procedures from 2005 to 2013 was reviewed. A small anterolateral left thoracotomy allowed left internal mammary artery harvest, proximal anastomoses on the ascending aorta, and distal coronary anastomoses. Early cases were compared with the later cases, focusing on grafting strategies that led to a standardized approach with Propensity Score Matching analysis. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Seven hundred consecutive cases were divided into early (1–200) and late (201–700) groups. In the late group, the number of triple-vessel disease patients trended higher (50% vs. 57%, P = 0.0674) and the number of bypasses increased (2.3 ± 0.8 vs. 2.7 ± 1.0, P &lt; 0.0001). Conversion to sternotomy significantly decreased between the groups (6% vs. 0.6%, P &lt; 0.0001). There was no difference in rate of postoperative complications between the groups except for prolonged intubation (10% vs. 5%, P = 0.0236) and shortened length of stay (5.9 ± 6.7 vs. 5.5 ± 6.0, P = 0.0268). Propensity score matching analysis (n = 177) was significant for total bypass performed and time per bypass ( P &lt; 0.05). The late group was further divided into subgroups of one hundred each (subgroup 1 through 5). Operative times differed significantly (subgroup 1: 249 ± 71.2, subgroup 2: 259 ± 85.8, subgroup 3: 244 ± 71.0, subgroup 4: 270 ± 58.4, and subgroup 5: 246 ± 47.9, P &lt; 0.005). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> As experience with minimally invasive coronary surgery coronary artery bypass grafting increased, the ideal sequence of steps to optimize surgical outcome was defined. The number of bypassed vessels increased and the operative time and conversion to sternotomy decreased. </jats:p></jats:sec>

The efficacy of minimally invasive coronary artery bypass grafting (mics cabg) for patients with coronary artery diseases and diabetes: a single center retrospective study

“…The difficulty of proximal anastomosis at the ascending aorta is generally greater in MICS CABG than in CCABG due to the small incision size and distance from the ascending aorta. Therefore, as recommended in previous research [ 7 , 16 ], IMA was used in the MICS CABG group to reduce the number of proximal anastomosis, and sequential bridge anastomosis was performed on SVG. Herein, IMA was essential in the preoperative evaluation of MICS CABG.…”

The Efficacy of Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) for Patients with Coronary Artery Diseases and Diabetes: A Single Center Retrospective Study

“…The di culty of proximal anastomosis at the ascending aorta is generally greater in MICS CABG than in CCABG due to the small incision size and distance from the ascending aorta. Therefore, as recommended in previous research [7,14] , IMA was used in the MICS CABG group to reduce the number of proximal anastomosis, and sequential bridge anastomosis was performed on SVG. Herein, IMA was essential in the preoperative evaluation of MICS CABG.…”

“…In contrast to CCABG, MICS CABG does not require sternotomy, which not only reduces postoperative pain but also aids in postoperative expectoration and early rehabilitation training [14,20] . Herein, compared to patients undergoing CCABG, patients receiving MICS CABG had a slightly longer surgical duration but with less intraoperative blood loss and a shorter length of stay post-surgery.…”

Surgical Challenges in Multi-Vessel Minimally Invasive Coronary Artery Bypass Grafting

“…These procedures were performed by surgeons proficient in performing the traditional OPCABG operations, and challenges were likely attributable to unexpected or specific difficulties associated with the adaptation to the unfamiliar surgical equipment or surgical field used for the MICS CABG procedure. There is an inherent learning curve for surgeons conducting multi-vessel lesions off-pump MICS CABG [ 11 – 13 ]. Primary technical challenges encountered in our case series were associated with issues of exposure, proximal and distal anastomosis, LITA availability, and lung problems.…”