Minimally invasive coronary artery bypass grafting through left minithoracotomy

• Kiladze I.Z.
• Zhbanov I.V.
• Gela V. Lev
• Maklagina A.V.
• Shabalkin B.V.

Abstract

Background. Minimally invasive coronary artery bypass grafting through left minithoracotomy is a relatively new technology, but it has already shown good results. This technology helps avoid possible problems connected with post-sternotomy wound healing in a high-risk group. Such operations provide perioperative complication risk reduction and patients' rapid rehabilitation.

Aim. Evaluate the results of minimally invasive coronary artery bypass grafting operations. Material and methods. 80 operations of minimally invasive bypass surgery through left-sided minithoracotomy were performed in our department from November 2018 to December 2020. The average age of patients was 61.5±7 years, of which 78.8% were men, and 21.2% women. The mean ejection fraction of the left ventricle equaled 59.3±13.7%.

Results. Bypass surgery without assisted circulation bypass was performed in 74 cases through minithoracotomy, and in 6 cases by the means of ON-PUMP beating heart. The duration of the operation was 264±90 minutes. Revascularization index was 2.5±0.8. Bimammary bypass surgery was performed in more than 40% of cases. Intraoperative blood loss did not exceed 300 ml. The average mechanical ventilation time after surgery was just over 2.5 hours. In all patients, IMA was used to bypass the branches of the LCA. For revascularization of the LAD basin, LIMA was used in most cases (n=75), while in 15 cases the diagonal branch фх) was sequentially shunted. RITA was more often used to restore blood flow in the branches of CX (n=28). Only 5 patients underwent cross bimammary coronary artery bypass grafting, when RITA was used for LAD and LITA for CX branches. For revascularization of RCA and its branches, SVG or autoarterial (RA) conduits were used.

Conclusion. Minimally invasive bypass, even at the stage of its introduction into widespread clinical practice, is accompanied by a low rate of perioperative complications and the hospital mortality absence, as well as short duration of ICU stay and, in general, of postoperative hospital stay.

Keywords:coronary artery bypass grafting, minimally invasive myocardial revascularization, multiple coronary artery bypass grafting through left minithoracotomy, MICS CABG, coronary heart disease

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