Minimally Invasive Coronary Artery Bypass Grafting: A Review.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) management often involves surgical or transcatheter interventions.
• Conventional coronary artery bypass grafting (CABG) utilizes cardiopulmonary bypass, posing risks for certain patient groups.
• Transcatheter interventions, while less invasive, face challenges with restenosis rates.

Purpose of the Study:

• To evaluate minimally invasive CABG (MIDCAB) without cardiopulmonary bypass as an alternative treatment.
• To identify patient selection criteria and potential benefits of MIDCAB.
• To compare MIDCAB with conventional CABG and transcatheter interventions.

Main Methods:

• Review of existing literature and clinical experience with MIDCAB procedures.
• Analysis of patient outcomes, including operative time, blood loss, hospital stay, and complications.
• Discussion of hybrid approaches combining MIDCAB with transcatheter interventions for multivessel disease.

Main Results:

• MIDCAB is suitable for isolated proximal stenoses (LAD/RCA) or recurrent disease, especially in elderly/high-comorbidity patients.
• Benefits include smaller incisions, reduced operating time, fewer arrhythmias, less blood loss, shorter hospital stays, and lower costs.
• Advancements in stabilization devices may expand MIDCAB applicability to posterolateral coronary branches.

Conclusions:

• MIDCAB is a valuable option for selected CAD patients, offering significant advantages over conventional CABG and transcatheter methods.
• Technical challenges and unknown long-term results necessitate careful patient selection and discourage widespread, indiscriminate use.
• While stenting is improving, conventional CABG remains the gold standard for durable CAD treatment due to lower restenosis rates.