Endo-Aortic Clamping with the IntraClude® Device in Minimally Invasive Total Coronary Revascularization via Left Anterior Thoracotomy (TCRAT)

Minimally invasive, sternum-sparing total coronary revascularization in multivessel disease via left anterior mini-thoracotomy (TCRAT) was introduced recently. Intra-aortic balloon occlusion is a conceivable option to avoid manipulation of the ascending aorta, to reduce the risk of stroke and to be able to treat patients with severe calcifications and unfavorable aortic anatomies. <b>Background/Objectives</b>: The aim of our study was to show that the use of the IntraClude^® device, as part of minimally invasive coronary artery bypass grafting (CABG) via left anterior mini-thoracotomy, is feasible. <b>Methods</b>: From May to December 2023, CABG via left anterior mini-thoracotomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in 20 patients (17 male, 67.6 ± 8.2 (51-82) years). All patients had significant coronary artery disease (three-vessel: <i>n</i> = 6; two-vessel: <i>n</i> = 11; one-vessel: <i>n</i> = 3) with indication for surgical revascularization. The mean EuroScore2 was 2.6. <b>Results</b>: All patients successfully underwent minimally invasive CABG using endo-aortic balloon occlusion. A total of 43 distal anastomoses (2.2 ± 0.6 (1-3) per patient) were performed by using left internal artery mammary (<i>n</i> = 20) and radial artery (<i>n</i> = 14) for grafting the left anterior descending (<i>n</i> = 19), circumflex (<i>n</i> = 15) and right (<i>n</i> = 6) coronary artery. There was no hospital mortality, no stroke, no myocardial infarction or repeat revascularization. A total of 15 out of 20 patients left hospital within 8 days after surgery. <b>Conclusions</b>: TCRAT by using the IntraClude^® device is feasible without compromising surgical principles while avoiding the external manipulation of the ascending aorta. The use of intra-aortic balloon occlusion instead of transthoracic clamps further reduces the invasiveness of the procedure.