Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future?

Abstract

Objective: The aim was to show that total arterial revascularization via a left minithoracotomy using bilateral internal thoracic arteries was not only feasible but also a safe and reproducible procedure with excellent midterm outcomes.

Methods: From August 2011 to August 2016, 819 patients underwent off-pump minimally invasive multivessel coronary artery bypass grafting using bilateral internal thoracic arteries harvested through a 2-inch left minithoracotomy incision, and complete revascularization of the myocardium was performed using the left internal thoracic artery-right internal thoracic artery Y composite conduit.

Results: A total of 819 patients underwent minimally invasive total arterial myocardial revascularization using bilateral internal thoracic arteries (left internal thoracic artery-right internal thoracic artery Y composite conduit) via a left minithoracotomy. The average number of grafts was 3.1. A total of 171 patients (21%) had 4 grafts, and 557 patients (68%) had 3 grafts. There were 6 mortalities (0.7%), and 4 patients (0.4%) had an elective conversion to sternotomy because of hemodynamic instability. The average hospital stay was 3.1 days. Coronary angiograms were performed in 195 patients (23%), and computed tomography angiograms were performed in 172 patients (21%) at 12 months; the grafts were patent. Four patients (0.4%) required reintervention with angioplasty.

Conclusions: Multivessel total arterial revascularization was performed using the left internal thoracic artery-right internal thoracic artery Y composite conduit via a left minithoracotomy and showed that it was safe and reproducible. The midterm outcomes have been good, and coronary angiograms showed widely patent grafts. This novel technique may help optimize minimally invasive coronary surgery and the use of bilateral internal thoracic arteries. Further, this technique has the potential for decreased morbidity, shorter hospital stay, cosmesis, and earlier return to active life.

Keywords: coronary artery bypass grafting; internal thoracic arteries; left minithoracotomy; minimally invasive.