Minimally invasive multivessel coronary artery bypass grafting: a single center's experience of 600 cases-reprint (reprint)

Aim: to assess the safety and efficacy of multivessel minimally invasive coronary artery bypass grafting (MICS CABG) in the immediate and midterm period.
Materials and methods: a cohort study included 611 patients with multivessel coronary artery disease who underwent MICS CABG between 2011 and 2022. All patients underwent complete myocardial revascularization via left mini-thoracotomy on the beating heart. The mean patient age was 58.9±8.1 years; 87 (14.2%) were women. Diabetes mellitus was present in 129 (21.1%) patients, and obesity in 233 (38.1%). The mean EuroScore II was 1.2±0.7 and the mean SyntaxScore was 26.7±8.9.
Results: the mean operation time was 261.7±93.5 minutes, with a mean of 2.5±0.7 distal anastomoses. Mammary coronary artery bypass grafting was performed in 292 (47.8%) patients, while 319 (52.2%) underwent coronary artery bypass surgery without aortic manipulation. Cardiopulmonary bypass was used in 25 (4.1%) patients, including emergency conversion in 14 (2.3%). The median intraoperative blood loss was 250 (200; 300) mL, and the 24-hour blood loss after the intervention was 270 (150; 350) mL. Blood transfusion and its components was required in 56 (9.2%) patients. No cases of deep wound infection were observed. Perioperative stroke occurred in 2 (0.33%) patients, myocardial infarction – in 8 (1.3%) patients. The 30-day mortality was 0.49% (n=3). The postoperative in-hospital stay was 7 (7; 10) days, and the median recovery time was 14 (9; 24) days. With a median follow-up of 5.1 (3.2; 7.1) years, the 8-year cumulative survival rate was 91.4% and freedom from major adverse cardiac and cerebrovascular events was 87.6%.
Conclusion: MICS CABG is a safe procedure associated with a low incidence of perioperative complications, conversions to cardiopulmonary bypass, and sternotomy, as well as short hospital stays and rapid recovery. MICS CABG can be applied to patients with multi-vessel coronary artery disease, maintaining the effectiveness in the mid-term follow- up, comparable to traditional CABG. MICS CABG is a reproducible operation, but is more demanding on surgical skills and requiring patient selection, especially during the initial learning curve.

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