Minimally Invasive Off-Pump Coronary Artery Bypass as Palliative Revascularization in High-Risk Patients

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Interventional Cardiology

Background:

• Multivessel coronary artery disease (MV CAD) in high-risk, frail patients presents significant morbidity and mortality risks with conventional complete revascularization.
• Minimally invasive direct coronary artery bypass (MIDCAB) and minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) serve as palliative options when catheter interventions are unsuitable and traditional coronary artery bypass grafting (CABG) is too risky.

Purpose of the Study:

• To assess the safety and clinical outcomes of palliative revascularization using MIDCAB or MICS-CABG in high-risk patients with MV CAD.
• To evaluate the impact of these minimally invasive approaches on overall survival in a selected patient cohort.

Main Methods:

• A consecutive series of 57 high-risk patients with MV CAD underwent palliative MIDCAB or MICS-CABG between 2008 and 2018.
• Procedures involved single or double-vessel revascularization using endoscopically harvested internal thoracic artery, radial artery, or saphenous vein grafts.
• Mean follow-up was 4.2 ± 3.7 years, with a 91.2% follow-up rate.

Main Results:

• The study included elderly, predominantly male patients with significant comorbidities such as atrial fibrillation, chronic kidney disease, and impaired ejection fraction.
• Forty-eight MIDCAB and nine MICS-CABG procedures were performed without conversion to sternotomy or cardiopulmonary bypass (CPB).
• Early mortality was 7% (4 patients), with low rates of myocardial infarction and no immediate reoperations; one-, three-, and five-year survival rates were 83%, 67%, and 61%, respectively.

Conclusions:

• MIDCAB and MICS-CABG are safe and effective palliative surgical options for high-risk, multimorbid patients with MV CAD.
• The observed early and mid-term clinical outcomes surpassed predictions, suggesting the benefit of these less invasive techniques.
• Exploring hybrid procedures more frequently in selected cases may further enhance long-term patient outcomes.