MICS CABG: a single-center experience of the first 100 cases

Abstract

Purpose: To study the learning curve and outcomes of the first 100 cases of minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG) performed at our center.

Methods: From January 2017 to November 2019, a total of 100 patients underwent CABG via left anterior thoracotomy approach. We have studied the operative times within the MICS CABG patients to analyze our learning curve. We also studied the postoperative outcomes and compared these with those of patients who underwent sternotomy during the same period.

Results: The mean age was 59.33 ± 9.95 (range 37-82) years. The numbers of males and females were 72 and 28 respectively. The preoperative average ejection fraction (EF) was 51.08 ± 9.75%. All these patients underwent CABG via left thoracotomy approach, after satisfying the exclusion criteria. All patients received left internal mammary artery (LIMA) to left anterior descending (LAD) as a standard graft, with the radial artery and saphenous vein being the next alternative conduits. The average length of the incision was 6.06 ± 0.45 cm. Only 2 cases were done on pump. The average number of grafts per patient was 2.33 ± 0.92. The mean operative time was 132.40 ± 11.56 min. The mean duration of ventilation was 4.79 ± 1.90 h and average intensive care unit (ICU) stay was 2.62 ± 0.84 days. There was one conversion and no mortalities in our study. We had analyzed our operative times and noticed a significant reduction after the first 20 cases, which was our learning curve.

Conclusion: MICS CABG can be performed for multivessel disease with the same comfort as for a single or a double vessel disease, once the learning curve has been achieved. Only significant difference from the sternotomy approach was noted in the longer operative times for MICS CABG during the learning curve, and not thereafter. Significant benefits of MICS over sternotomy were noticed in the immediate postoperative parameters like duration of ventilation, mean drainage, postoperative pain, ICU stay, and hospital stay, with no difference in postoperative adverse events.

Keywords: Learning curve; MICS CABG; Multivessel bypass.

Fig. 1

Postoperative image wherein the scar is being measured. On the medial aspect of the chest, midline (dashed line) is marked as well as the 2nd, 3rd, and 4th intercostal spaces (horizontal lines). The epicardial pacing wire and the intercostal drainage tube are also seen

Fig. 2

a Intraoperative image showing the usage of Starfish cardiac positioner to lift the apex while the Nuvo Octopus myocardial stabilization device is used to position for grafting the obtuse marginal (OM) artery. b Intraoperative image where SVG was used to graft the OM (white arrow). In this case, the conventional Octopus was utilized and was fixed to the rib spreader

Fig. 3

The graphical representation of number of grafts performed over the period of 3 years. The percentage of the number of grafts on Y axis and the year it was performed on X axis

Fig. 4

A scatter plot, in serial order of each patient who underwent single and double vessel disease plotted on X axis with the operative time of each patient plotted on the Y axis

Fig. 5

Postoperative CT coronary angiography image showing LIMA-Radial Y anastomosis. LIMA grafted to LAD and radial artery grafted to obtuse marginal artery