Proximal Chronic total occlusion of the left anterior descending Coronary Artery: Conventional vs. Minimally Invasive Revascularization

Introduction Minimally invasive techniques have gained much popularity in recent years. Our goal is comparing the initial outcomes of the minimally invasive technique to the traditional method for managing chronic total occlusion of the left anterior descending coronary artery. Methods A total of 60 ischemic individuals with isolated chronic total occlusion (CTO) of the left anterior descending coronary artery and a history of failed PCI were prospectively studied at the National Heart Institute, Cairo, Egypt, between June 2021 to November 2023. Patients were matched using EuroSCORE II, all patients were operated on utilizing the off-pump technique. Group 1 encompassed 30 patients who had CABG via the conventional mid-sternotomy approach, whereas Group 2 comprised 30 patients who underwent minimally invasive direct coronary artery bypass grafting (MIDCAB). Data on demographics, intraoperative, and postoperative parameters were gathered and analyzed for comparison. Results We had no mortality among the participating patients. Group 2 experienced a significantly extended surgery duration (335.6 ± 76.3 vs. 282.7± 53.4 minutes, P = 0.028). The minimally invasive group had significantly less blood loss during the surgery (376.31± 158.63 vs. 519.54± 171.84 ml, P = 0.003), shorter duration of ventilation (242 ± 194.76 vs. 494.00 ± 332.45 minutes, P = 0.002), shorter ICU stay (1.73 ± 0.55 vs 2.25 ± 0.67 days, P = 0.003), and shorter hospitalization (4.53 ± 1.43 vs. 5.74 ± 1.4 days, P = 0.003). Postoperative blood loss, blood transfusion requirements, and the inotrope infusion duration showed insignificant differences between the two groups. Conclusion Patients who underwent minimally invasive coronary artery bypass grafting (MIDCAB) showed less frequent intraoperative blood loss, lesser postoperative analgesic use, and quicker recovery.