Abstract
Background Advancement in the field of cardiovascular surgery has emerged with various minimally
invasive approaches for the treatment of multivessel coronary disease to improve outcomes
and minimize the burden associated with conventional cardiac surgery. This study describes
our routine technical approach and clinical experience of minimally invasive coronary
artery bypass via left anterior minithoracotomy for the treatment of patients with
multivessel coronary lesions.
Methods Our experience includes 100 consecutive patients who were operated between July 2020
and April 2021. The left internal thoracic artery was harvested in all patients. Radial
arterial grafts and saphenous vein grafts were harvested endoscopically. Patients
were operated either under cardiopulmonary bypass (CPB) with blood cardioplegia through
left anterior minithoracotomy of 5 to 7 cm or off-pump via left anterolateral minithoracotomy.
Results We had single mortality (1%), no early postoperative myocardial infarction was observed.
None of our patients was converted to sternotomy (0%). The mean number of bypass was
3.1 ± 0.8, the mean cross-clamping time was 78.1 ± 20.6 minutes, the mean CPB time
was 153.2 ± 37.5 minutes, the average intubation time was 6.33 ± 11.29 hours, the
mean intensive care unit stay was 1.62 ± 1.78 days, the mean hospital stay was 4.98 ± 3.01
days, the average total operation time was 4.20 ± 0.92 hours, and the average pleural
drain was 393.8 ± 169.7 mL.
Conclusion Minimally invasive coronary artery bypass grafting via left anterior minithoracotomy
can be routinely performed with safety and it is feasible, reproducible with a short
learning curve. Further multicenter studies are needed for the standardization of
our technique.
Keywords
minimal invasive surgery (minithoracotomy) - cardiopulmonary bypass - coronary artery
bypass grafting
