[Minimally Invasive Coronary Artery Bypass Grafting Using Bilateral In Situ Internal Thoracic Arteries]

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Diabetic Cardiovascular Complications

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for severe coronary artery disease.
• Minimally invasive coronary artery grafting (MICS CABG) aims to reduce surgical morbidity, particularly in diabetic patients prone to infection.
• The use of bilateral internal thoracic arteries (BITA) is associated with superior long-term graft patency compared to single internal thoracic artery or saphenous vein grafts.

Observation:

• A 73-year-old male with diabetes mellitus and three-vessel coronary disease underwent MICS CABG.
• In situ bilateral internal thoracic arteries (BITA) were harvested and utilized for grafting to the left anterior descending artery (LAD) and high lateral branch (HL).
• An off-pump technique was employed for all anastomoses, including a saphenous vein graft (SVG) to the posterior descending artery.

Findings:

• The MICS CABG procedure was successfully completed without major postoperative complications.
• Postoperative 3D-computed tomography angiography (CTA) confirmed the patency of all grafts (RITA-LAD, LITA-HL, SVG-#4 PDA).
• The use of in situ BITA in a minimally invasive, off-pump setting proved feasible and yielded satisfactory graft quality.

Implications:

• Minimally invasive coronary artery bypass grafting using bilateral internal thoracic arteries is a safe and effective option for diabetic patients with complex coronary artery disease.
• This technique may improve long-term outcomes by ensuring robust arterial conduits and reducing the risk of surgical site infections.
• Further studies are warranted to validate these findings in larger patient cohorts and assess long-term efficacy.