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Total Arterial Multivessel Minimally Invasive Coronary Artery Bypass Surgery: 5-Year Outcomes
Alexander Verevkin1, Konstantin Von Aspern1, Hermann Tolboom1
1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
Insights
Minimally invasive coronary artery bypass graft (CABG) surgery using total arterial revascularization shows excellent outcomes. This approach, performed in specialized centers, offers a safe alternative to conventional CABG with superior results.
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.
Background:
Total arterial revascularization is associated with superior outcomes to conventional coronary artery bypass graft (CABG) surgery performed with the left internal thoracic artery (ITA) and veins. It is often performed with bilateral ITAs that increase risk of sternal wound infection. Minimally invasive multivessel CABG through a left anterior minithoracotomy eliminates sternal wound complications. However, being performed only in a few specialized centers, there is a paucity in follow-up outcome data. We, therefore, describe our 5-year single-center experience with such operations.
Methods:
Between 2015 and 2021, 186 patients underwent elective, total arterial minimally invasive CABG in our institution. Patient data were prospectively collected in the institutional database and retrospectively analyzed. Primary end points were in-hospital mortality and 5-year survival. The secondary end points included freedom from major adverse cerebrovascular and cardiac events.
Results:
Patients were a mean age of 66 ± 9 years, and 23 (12%) were women. The mean number of bypass grafts performed was 2.4 ± 0.5 (range, 2-4 grafts). Bilateral ITAs were used in 163 patients (88%) and left ITA and radial arteries in 22 (12%). The mean procedure time was 277 ± 58 minutes. There was 1 hospital death. Perioperative myocardial infarction, repeat thoracotomy, and conversion to sternotomy was observed in 6 (3%), 12 (6.5%), and 2 patients (1.1%), respectively. The mean 5-year survival was 93.3% ± 2.2%, and freedom from major adverse cardiac and cerebrovascular events was 83.8% ± 4.1%.
Conclusions:
Total arterial minimally invasive CABG is a feasible surgical approach yielding excellent short- and midterm results when performed in selected patients in specialized high-volume cardiac centers.
