Çaynak B, Sicim H. Routine minimally invasive approach via left anterior mini‐thoracotomy in multivessel coronary revascularization. J Card Surg. 2022;1‐8. doi:10.1111/jocs.16259

Median sternotomy has been the standard approach for performing coronary artery bypass surgery for years. As minimally invasive CABG techniques emerge and are proven more beneficial to patient recovery and outcomes, they are slow to become mainstream because many surgeons shy away from such procedures due to the complexity, patient selection and lengthy learning curve.

In their study published in the Journal of Cardiac Surgery, Cardiovascular Surgeons Çaynak and Sicim aimed to determine the feasibility that multi-arterial minimally invasive CABG could become common practice – applied to all patients without distinction and performed by most cardiothoracic surgeons.

The two-year study included performing minimally invasive on-pump multivessel CABG through the left anterior mini-thoracotomy in the fourth intercostal space on 184 non-selected patients (except redo patients or patients with porcelain aorta).

Overview of the Methods and Results

• Grafts 3.3 ± 0.5
• LIMA to LAD anastomosis 184 (all patients)
• CPB Time 144.5 ± 27.3 min
• Aortic Cross Clamp Time 82.1 ± 16.2 min
• Significant decrease in operation time after the first 20 patients
• Mean ICU Stay 1.2 ±0.7 days
• Mean Length of Stay 5.1 ± 1.2 days
• Mortality 0.54% (One Patient, delayed tamponade on POD 5)
• Discharged with Good Recovery 99.4%
• For operative technique and additional details, click here

Çaynak and Sicim retrospectively reviewed each case and noted the overall success without patient selection. The study shows safe, successful and satisfactory results using this method, even in obese, diabetic, low EF and COPD patients.  They suggest good planning with preoperative tomography screening, EVH, nerve blocks for postoperative pain control and LIMA-LAD in all patients.

The authors express, to be competitive in the field, surgeons must embrace the difficulty and the learning curve process for minimally invasive methods. They note that pump assistance provides the confidence surgeons need as they work through the learning curve.

The advantage of the technique used in this study compared to other minimally invasive coronary surgery techniques is the bloodless anastomoses site and cardioplegic heart. They state that with their technique, surgeons use the same anastomosis skills and tie all knots with their fingers just as in a traditional sternotomy approach. “It is an undeniable fact that the operating area is narrow, but with certain maneuvers, an excellent exposure can be achieved in a narrow space.”

Minimally invasive approaches result in fewer complications, faster recovery and better patient outcomes, making them more attractive to the patient as well as the surgeon striving for surgical excellence.

Delacroix-Chevalier: Empowering Surgeons’ Success in MICS CABG Techniques

MED Alliance Solutions offers a wide portfolio of innovative minimally invasive coronary bypass surgery solutions from Delacroix-Chevalier to empower cardiothoracic surgeons to deliver superior results.

With a concentration on quality and precision, the Delacroix-Chevalier MICS CABG platform is designed to accommodate specific surgical techniques such as the technique described in this study.

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MICS CABG Platform

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