Total Arterial Multivessel Minimally Invasive Coronary Artery Bypass Surgery: 5-Year Outcomes.

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Arterial Grafting

Background:

• Total arterial revascularization (TAR) offers superior outcomes compared to conventional coronary artery bypass graft (CABG) surgery.
• Bilateral internal thoracic arteries (ITAs) in TAR increase sternal wound infection risk.
• Minimally invasive multivessel CABG via left anterior minithoracotomy avoids sternal complications but lacks extensive outcome data.

Purpose of the Study:

• To evaluate the 5-year outcomes of minimally invasive, total arterial CABG performed at a single center.
• To assess the feasibility and efficacy of this advanced surgical technique.

Main Methods:

• Retrospective analysis of prospectively collected data from 186 patients undergoing elective, total arterial minimally invasive CABG (2015-2021).
• Primary endpoints: in-hospital mortality and 5-year survival.
• Secondary endpoints: freedom from major adverse cerebrovascular and cardiac events.

Main Results:

• Mean patient age 66 ± 9 years; 12% women.
• Mean 2.4 grafts per patient; bilateral ITAs used in 88%.
• Excellent outcomes: 93.3% ± 2.2% 5-year survival and 83.8% ± 4.1% freedom from MACE, with low in-hospital mortality (1 death) and complication rates.

Conclusions:

• Minimally invasive total arterial CABG is a feasible and effective surgical option.
• The procedure yields excellent short- and midterm results in selected patients.
• High-volume, specialized cardiac centers are crucial for successful implementation.