EARLY RESULTS OF MULTIVESSEL MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING

Background: Minimally Invasive coronary artery bypass grafting (MICS CABG) and Hybrid Revascularization (HR) are alternatives to sternotomy to reduce the procedure’s invasiveness. We aimed to assess the early and mid-term outcomes of MICS CABG. Methods: We retrospectively reviewed multivessel MICS CABG patients at Santa Maria Hospital, Bari, from 2017-2024. The primary outcome was 30-day and follow-up mortality. Results: Sixty-one patients underwent MICS CABG via left mini-thoracotomy, with mean 2.3±0.5 distal anastomoses using the left internal thoracic artery (LITA), right ITA (RITA), radial artery, or saphenous vein. Five MICS CABG patients (8.2%) had HR. More than half of MICS CABG cases were performed with planned peripheral cardiopulmonary bypass (CPB), without cross-clamping the Aorta. Of the total cohort, 26 patients (42.6%) received endoscopic MICS CABG, using 3D thoracoscopy for ITAs harvesting via bilateral ports in the 2nd, 3rd, and 4th IS, employing peripheral CPB and aortic clamping by Chitwood clamp at the second IS, with cardioplegia delivery via a 4 cm right anterior mini-thoracotomy. Distal anastomoses were performed via left anterior mini-thoracotomy, with subxiphoid manipulation of the emptied heart. Transit time flowmetry was used in all cases. No conversion to sternotomy was needed. No thirty-day mortality occurred, median ventilation was 4 [2-5] hours, and Intensive Care Unit-stay was 1 [1-2] days. All patients received graft evaluation via computerized tomography before hospital discharge. Mean follow-up was 2.9±1.9 years (max 5 years), with no deaths and 4 (1.9%) follow-up PCI. Conclusion: MICS CABG is safe and provides excellent early and mid-term outcomes.