Long-Term Results of Thoracoscopic Harvesting of the Internal Thoracic Artery

Aim: To compare the results of the internal mammary artery (IMA) harvesting under direct vision and by thoracoscopy.

Methods: 339 patients (249 men, 90 women) who underwent minimally invasive coronary artery bypass grafting – MIDCAB (n=303) and MICS CABG (n=36) in the period from February 2014 to July 2021 were included in the retrospective analysis. All the patients were assigned into two groups depending on the IMA harvesting. 174 patients were assigned to the OPEN group with IMA harvesting under direct vision through the left minithoracotomy and 165 patients were assigned to the ENDO group with endoscopic IMA harvesting. The primary endpoint was major adverse cardiovascular events (MACCE), the secondary endpoint was the 1-year graft patency.

Results: There was no perioperative mortality. Two patients died in the OPEN group due to the graft dysfunction in the early postoperative period. There were no cases of the in-hospital mortality in the ENDO group. The 4-year freedom from MACCE in the ENDO and OPEN groups was 92.8% and 93.3%, respectively (p = 0.82). The 53-months survival in the ENDO and OPEN groups was 89.1% and 91.3%, respectively (p=0.95). The 1-year patency of the IMA grafts (MIDCAB and MICS CABG) was similar in both groups - 92%. To determine the predictors of mortality and major cardiovascular events in the long-term period, a univariate analysis was performed. Based on the obtained results, there were no statistically significant predictors of mortality and major cardiovascular events.

Conclusion: Our study has confirmed that endoscopic IMA harvesting is a safe approach with good long-term outcomes. Endoscopic harvesting should be performed in cardiovascular centers experienced in performing minimally invasive artery bypass grafting.

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