Minimally invasive coronary artery bypass grafting: a systematic review

Abstract

To minimize surgical morbidity in coronary artery bypass grafting, minimally invasive cardiac surgery has gained popularity. Minimally invasive coronary artery bypass grafting offers unique advantages compared to conventional off-pump coronary artery bypass or minimally invasive direct coronary artery bypass in that it enables the surgeon to harvest and graft bilateral internal thoracic arteries via a small thoracotomy while being conducted completely off-pump. This review focuses on current evidence behind off-pump coronary artery bypass, multi-arterial revascularization, patient populations that would most benefit from bilateral internal thoracic artery minimally invasive coronary artery bypass grafting, the surgical technique, and early outcomes. By overcoming the perceived inability to utilize bilateral internal thoracic arteries in minimally invasive coronary artery bypass grafting, the new technique further expands the armamentarium of surgeons and cardiologists. Hybrid coronary revascularization with bilateral internal thoracic artery minimally invasive coronary artery bypass grafting further augments the appeal of the next generation of minimally invasive cardiac surgery.

Complete Coronary Revascularization via Left Anterior Thoracotomy

“…Technical difficulty has been known as the main limitation for all previously described minimally invasive multivessel coronary grafting techniques. 1,[3][4][5][6][7][8][9] These difficulties have led to a high selection of patients with special precautions and contraindications 1,[6][7][8][9] and to little spread of these techniques in the domain of coronary surgery. Our aim was to develop the minimally invasive coronary artery grafting technique, which could be safely applied in every patient with isolated coronary artery disease and would be reproducible by most surgeons with a short learning curve.…”

“…However, limited incisions are being increasingly used in minimally invasive multivessel coronary artery revascularizations. [1][2][3][4][5] Despite the advantages in the patient's recovery, the main limitations of these minimally invasive coronary artery revascularization techniques had been the technical difficulties, longevity of the procedures, complex technology, long learning curve, and selection of patients. [6][7][8][9] Since July 2017 we started to perform multivessel coronary artery bypass grafting (CABG) routinely through the left anterior minithoracotomy in all patients.…”

Evolution of Minimally Invasive Coronary Artery Bypass Grafting

“…14 Other collogues have outlines bilateral internal mammary artery harvesting and outcomes from MICS CABG approach for arterial conduits. 15,16 Contraindications Absolute contraindications to MICS CABG were emergency surgery with hemodynamic instability, severe pectus excavatum, and severe pulmonary disease. Relative contraindications were left subclavian stenosis, a left upper extremity arterio-venous graft, previous sternotomy CABG, morbid obesity, severe left ventricular dysfunction, and the absence of femoral pulses bilaterally.…”

Smoking Influence on the Outcomes and Complications of Coronary Bypass Surgery

“…После корректировки всех исходных характеристик прекращение курения оставалось независимым предиктором более низкой смертности Операция КШ является одним из самых эффек-тивных методов лечения ИБС, позволяющим паци-ентам вернуться к нормальной активной жизни, улучшить качество жизни, связанное со здоровьем [14]. Совершенствование хирургических методов, улучшение послеоперационного ухода приводит к снижению частоты послеоперационных осложне-ний после операции КШ, к увеличению продолжи-тельности жизни больных [15,16].…”