Endoscopic-Assisted Multivessel Off-Pump Coronary Artery Bypass Grafting: Experience of the First 100 Procedures

This study presents an overview of our technique and the perioperative outcomes for the first 100 patients who underwent minimally invasive endoscopic-assisted off-pump multivessel bypass grafting (endoscopic coronary artery bypass [endo-CAB]) at the Catharina Hospital in Eindhoven.

The first 100 patients undergoing multivessel endo-CAB from May 2022 to March 2024 were included in this retrospective, single-center, observational study (N=100). The study encompassed both elective and urgent surgical revascularization. In all cases, endoscopic-assisted harvesting of the internal mammary artery, radial artery, or saphenous vein was performed, followed by beating-heart anastomoses through a mini-thoracotomy.

A total of 226 distal anastomoses were performed, utilizing 102 left internal mammary arteries, 80 radial arteries, 30 right internal mammary arteries, and 14 saphenous veins. On average, each patient had 2.3 anastomoses. A Y graft configuration was employed in 78 patients, in-situ bilateral internal mammary artery inflow in 19 patients, and a proximal aortic graft in 3 patients. Four patients underwent concurrent arrhythmia surgery. Eleven patients received hybrid revascularization. There was 1 conversion to sternotomy (1%) and 3 instances where cardiopulmonary bypass was required (3%). The median operation time was 3.3 hours (interquartile range, 3.0-3.7 hours), and the median hospital stay was 4.0 days (interquartile range, 3-4 days). The in-hospital mortality rate was 1%.

Multivessel off-pump endo-CAB surgery can be safely performed with endoscopic-assisted conduit harvesting. Combining the benefits of a minimally invasive and anaortic approach may improve perioperative outcomes for patients requiring surgical revascularization. Further studies are necessary to establish the role of this technique in routine coronary surgery.