Minimally invasive coronary revascularization in elderly patients

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Geriatric Cardiology

Background:

• Internal mammary artery (IMA) to left anterior descending (LAD) coronary artery anastomosis can be performed off-pump on a beating heart.
• This technique demonstrates potential benefits for elderly patients (≥70 years).

Purpose of the Study:

• To evaluate the safety and efficacy of minimally invasive coronary artery bypass grafting (CABG) in elderly patients.
• To assess outcomes of off-pump IMA-LAD anastomosis in a geriatric population.

Main Methods:

• A cohort of 27 elderly patients underwent minimally invasive CABG via left minithoracotomy.
• Procedures involved off-pump IMA-LAD anastomosis, with some patients having prior percutaneous interventions.
• One conversion to sternotomy was necessary due to intraoperative challenges.

Main Results:

• All patients survived the surgery with no perioperative myocardial infarction.
• Rapid recovery observed: extubation within 4 hours, mean ICU stay of 20.3 hours, and mean postoperative stay of 7.4 days.
• Postoperative angiography in 9 patients confirmed 100% graft patency.

Conclusions:

• Minimally invasive coronary revascularization of the anterior wall is feasible in elderly patients.
• The procedure is associated with low risk and favorable short-term outcomes.
• Off-pump IMA-LAD grafting is a viable option for selected elderly cardiac patients.