A review of nomenclature in minimally invasive coronary artery bypass grafting-the anarchy of terminology

Abstract

Objectives: Since the development of minimally invasive coronary surgery, nomenclature has rapidly grown to distinguish each unique method. The goal of this review was to provide a comprehensive overview of the different terms used for minimally invasive coronary bypass grafting through the years.

Methods: A literature search was performed in August 2024 using the PubMed electronic database. To extract the best search results: "minimally invasive" and "coronary artery bypass grafting" were used as either keywords or MeSH terms. The term robotic was specifically included for a second search. Eligible articles for this review were articles using an abbreviation to describe minimally invasive coronary artery bypass grafting.

Results: A total of 2118 publications on non-robotic minimally invasive coronary procedures and 392 on robotic-assisted techniques were reviewed, describing 40 unique terms for the procedure. Procedures were grouped based on left internal mammary artery harvest and anastomosis methods: mini-thoracotomy for both harvesting and coronary anastomosis (n = 586), endoscopic harvest with mini-thoracotomy (n = 37), robotic harvest with mini-thoracotomy (n = 144) and closed-chest revascularization (n = 140). Minimally invasive direct coronary artery bypass grafting was the most studied technique (486 publications, non-robotic and robotic), followed by closed-chest totally endoscopic coronary artery bypass (n = 124).

Conclusions: In conclusion, a wide variety of terms are used within the field of minimally invasive coronary surgery. A total of 40 different terms have been published, each describing certain specifics of the procedure. For anyone involved in the field of minimally invasive surgery, it is important to understand the differences and similarities of these procedures.

Keywords: CABG; LAST; MICS; MIDCAB; TECAB; coronary artery bypass grafting; minimally invasive.

Graphical abstract

Figure 1:

Classification based on site of incision, mammary artery harvesting technique and use of cardiopulmonary bypass. CPB: coronary pulmonary bypass.

Figure 2:

The search strategy illustrated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, diagram. A total of 40 unique terms were identified and included. EACAB: endoscopic atraumatic coronary artery bypass; ECABG: endoscopic coronary artery bypass grafting; EndoACAB: endoscopic atraumatic coronary artery bypass grafting; Endo-A-CAB: minimally invasive coronary artery bypass; Endo-CAB: endoscopic coronary artery bypass grafting; Endo-CABG: endoscopic coronary artery bypass grafting; LAST: left anterior small thoracotomy; MACAB: minimally invasive off-pump anaortic coronary artery bypass; MICS CABG: minimally invasive cardiac surgery; MICSOPCAB: minimally invasive cardiac surgery off-pump coronary artery bypass; MICS-TACR: minimally invasive coronary surgery–total arterial coronary revascularization; MICAB: minimally invasive coronary artery bypass; MICABG: minimally invasive coronary artery bypass grafting; MIDCAB: minimally invasive direct coronary artery bypass grafting; MIDCABG: minimally invasive direct coronary artery bypass grafting; MIDCABG-endo: endoscopic minimally invasive direct coronary artery bypass grafting; MID-OPCAB: minimally invasive direct off-pump coronary artery bypass grafting; Mini-OPCAB: mini off-pump coronary artery bypass; MVST: no-touch aorta multivessel small thoracotomy coronary artery bypass grafting; PA-CAB: port access coronary artery bypass; PA-CABG: port-access coronary artery bypass grafting; RADCAB: robotic-assisted minimally invasive direct coronary artery bypass; RA-CABG: robotic-assisted coronary artery bypass grafting; RACAB: robotic-assisted coronary artery bypass; RAMIDCAB: robotic-assisted minimally invasive direct coronary artery bypass; RAVECAB: robot-assisted, video-enhanced coronary artery bypass; RAVECABG: robot-assisted, video-enhanced coronary artery bypass grafting; RCAB: robotic coronary artery bypass; RCABG: robotic coronary artery bypass grafting; RE-MIDCAB: robotically enhanced minimally invasive direct coronary artery bypass; RHCR: robotic hybrid coronary revascularization; RMIDCAB: robotic-assisted minimally invasive direct coronary artery bypass; SAX-CAB: subclavian/axillary artery to coronary artery bypass; TCAB: transabdominal endoscopic computer-enhanced coronary artery bypass; TCRAT: total coronary revascularization through left anterior thoracotomy; TECAB: closed-chest totally endoscopic coronary artery bypass; TECABG: totally endoscopic coronary artery bypass grafting; ThoraCAB: robot-assisted minimally invasive direct coronary artery bypass grafting; TM-OPCAB: lower distal mini-sternotomy; µCAB: customized technology for subxiphoid internal mammary artery harvest.

Figure 3:

Overview of publications over the years per term of non-robotic minimally invasive coronary artery bypass approaches. EACAB: endoscopic atraumatic coronary artery bypass; EndoACAB: endoscopic atraumatic coronary artery bypass grafting; Endo-CAB: endoscopic coronary artery bypass grafting; Endo-CABG: endoscopic coronary artery bypass grafting; LAST: left anterior small thoracotomy; MACAB: minimally invasive off-pump anaortic coronary artery bypass; MICS CABG: minimally invasive cardiac surgery; MICSOPCAB: minimally invasive cardiac surgery off-pump coronary artery bypass; MICS-TACR: minimally invasive coronary surgery-total arterial coronary revascularization; MICAB: minimally invasive coronary artery bypass; MICABG: minimally invasive coronary artery bypass grafting; MIDCAB: minimally invasive direct coronary artery bypass grafting; MIDCABG: minimally invasive direct coronary artery bypass grafting; MID-OPCAB: minimally invasive direct off-pump coronary artery bypass grafting; Mini-OPCAB: mini off-pump coronary artery bypass; MVST: no-touch aorta multivessel small thoracotomy coronary artery bypass grafting; PA-CABG: port-access coronary artery bypass grafting; SAX-CAB: subclavian/axillary artery to coronary artery bypass; TCRAT: total coronary revascularization through left anterior thoracotomy; ThoraCAB: robot-assisted minimally invasive direct coronary artery bypass grafting; TM-OPCAB: lower distal mini-sternotomy; µCAB: customized technology for subxiphoid internal mammary artery harvest.

Figure 4:

Overview of publications over the years per term of robotic minimally invasive coronary artery bypass approaches. ECABG: endoscopic coronary artery bypass grafting; Endo-A-CAB: minimally invasive coronary artery bypass; MIDCAB: minimally invasive direct coronary artery bypass grafting; MIDCABG-endo: endoscopic minimally invasive direct coronary artery bypass grafting; PA-CAB: port access coronary artery bypass; RADCAB: robotic-assisted minimally invasive direct coronary artery bypass; RA-CABG: robotic-assisted coronary artery bypass grafting; RACAB: robotic-assisted coronary artery bypass; RAMIDCAB: robotic-assisted minimally invasive direct coronary artery bypass; RAVECAB: robot-assisted, video-enhanced coronary artery bypass; RAVECABG: robot-assisted, video-enhanced coronary artery bypass grafting; RCAB: robotic coronary artery bypass; RCABG: robotic coronary artery bypass grafting; RE-MIDCAB: robotically enhanced minimally invasive direct coronary artery bypass; RHCR: robotic hybrid coronary revascularization; RMIDCAB: robotic-assisted minimally invasive direct coronary artery bypass; TCAB: transabdominal endoscopic computer-enhanced coronary artery bypass; TECAB: closed-chest totally endoscopic coronary artery bypass; TECABG: totally endoscopic coronary artery bypass grafting; ThoraCAB: robot-assisted minimally invasive direct coronary artery bypass grafting.

Figure 5:

Visualization of the different incisions and port-access points used during minimally invasive coronary surgery. Incisions: (1) Subclavian/axillary artery to coronary artery bypass clavicular incision; (2) third intercostal mini-thoracotomy incision; (3) left anterior small thoracotomy or minimally invasive coronary artery bypass; (4) partial inferior hemi-sternotomy for lower distal mini-sternotomy; (5) internal mammary artery harvest incision for customized technology for subxiphoid internal mammary artery harvest. (A–C) Non-robotic and robotic endoscopic internal mammary artery harvest port placement locations; (D, E) robotic closed-chest revascularization port placement locations.

Figure 6:

Pictures illustrating the different approaches to minimally invasive internal mammary artery harvest. (A) Illustrates direct vision harvest as described by Ruel [50]; (B) illustrates the non-robotic endoscopic assisted internal mammary artery harvest as performed at our institute; (C) and (D) illustrate the robotic-assisted internal mammary artery harvest set-up and the internal mammary artery harvest as described by Torregrossa and Balkhy [51, 52].