IN-HOSPITAL OUTCOMES OF MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING

Aslidin B. Nishonov; Salokhiddinkhoja I. Iskandarov; Sergey V. Ivanov; Alexander N. Kokov; Roman S. Tarasov

IN-HOSPITAL OUTCOMES OF MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING

Aslidin B. Nishonov, Salokhiddinkhoja I. Iskandarov, Sergey V. Ivanov, Alexander N. Kokov, Roman S. Tarasov

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Abstract

Highlights

Modern cardiac surgery techniques are designed to minimize intervention in stenting, allowing these procedures to be performed on a wider range of patients. In this regard, the intra- and postoperative aspects of minimally invasive coronary artery bypass grafting (MICABG) are of interest, demonstrating the advantages of this procedure.

Background. Minimally invasive coronary artery bypass grafting (MIDCABG) reduces surgical trauma in patients with coronary artery disease, especially when complete myocardial revascularization is not possible. However, technical difficulties can impact the quality of the mammary coronary anastomosis, resulting in dysfunction of the most important bypass graft in coronary surgery.

Aim. To analyze the in-hospital outcomes of mammary coronary artery bypass grafting using lateral minithoracotomy.

Methods. A total of 72 cases of minimally invasive coronary artery bypass grafting via lateral minithoracotomy (MIDCAB) were selected in 2025 (Group I) using a continuous sampling method. A comparison group of 67 cases of isolated mammary coronary artery bypass grafting via median sternotomy was selected using a continuous sampling method in 2021–2025 (Group II). Clinical, demographic, and intraoperative data, as well as in-hospital outcomes, were analyzed.

Results. According to the main clinical and demographic data, the patients were comparable. The mean age was 64.9 ± 7.2 and 67 ± 5 years (p = 0.1). The main cohort of patients consisted of patients with angina pectoris of functional class I–II (90.3% and 81%, p = 0.4), functional class III–IV was noted in 8.3% and 12% of patients, the remaining patients had acute coronary syndrome (1.4% versus 7%, p = 0.08). Multivessel disease was statistically significantly more common in patients with median sternotomy (36.1% versus 52.2%, p = 0.045). The left ventricular ejection fraction was significantly lower in the sternotomy group (61.6 ± 5.7 versus 57.1 ± 10.6, p = 0.01). In the MIDCAB group, the operative time was significantly shorter (119 ± 19 vs. 129.8 ± 23 minutes, p = 0.04), and the diameter of the installed intracoronary bypass graft was significantly smaller (1.6 ± 0.2 vs. 1.8 ± 0.2, p = 0.0001). There was no in-hospital mortality in the groups, 1 (1.4%) perioperative myocardial infarction was noted in the MIDCAB group, and 1 case of acute cerebrovascular accident in the sternotomy group. No significant differences were found in the aspect of the development of major cardiovascular catastrophes (1.4% vs. 3%, p = 0.5). The duration of postoperative hospital stay was statistically significantly shorter in the MIDCAB group (9 ± 2 vs. 11 ± 3 days, p = 0.004).

Conclusions. Mammary coronary artery bypass grafting from lateral minithoracotomy is a safe and effective method of myocardial revascularization, including in patients with multivessel coronary disease, in whom complete myocardial revascularization is impossible.