Total coronary revascularization with anterior thoracotomy: it’s not just about sternotomy

In coronary artery bypass graft (CABG) surgery, various forms of minimally invasive approaches have been defined. The research evaluates TCRAT technique against traditional CABG methods through analysis of their effects on surgical results and postoperative clinical performance. We report a comparative analysis of 75 TCRAT and 75 conventional CABG cases that we performed using cardiopulmonary bypass (CPB) and cardioplegic arrest between February 2021 and August 2022. The patients received clinical and echocardiographic follow-up for an average period of 17.05 ± 4.13 months. We compared our first 75 TCRAT cases to the 75 conventional CABG cases we performed during the same time period. Mean CPB duration (113.9 ± 24.3 vs. 95.7 ± 20.1 min, p = 0.001) and mean cross-clamp duration (71.5 ± 18.2 vs. 58.3 ± 14.7 min, p = 0.003) of the TCRAT group were found to be significantly longer than those of the conventional CABG group. Hospital length of stay was significantly shorter in the TCRAT group (5.2 ± 1.8 vs. 6.8 ± 2.3 days, p = 0.003). Throughout the follow-up period, patients in both groups experienced a 47% reduction in the mean New York Heart Association (NYHA) functional class. The study followed patients for 17.05 ± 4.13 months without detecting any signs of graft blockage through clinical or echocardiographic assessments although angiographic verification was not standard practice. In employed patients, the time to return to work was an average of 16 days in the TCRAT group, while in the conventional CABG group, this duration exceeded 2 months. TCRAT has proven its ability to deliver results similar to traditional CABG in the short term through our first experience with the procedure while providing sternotomy-free benefits that lead to reduced hospitalization duration and quicker recovery of daily activities. The technique requires additional research to determine its cost-effectiveness and identify suitable patient groups through formal economic assessments and extended follow-up studies.