Introduction
For several decades, coronary artery bypass grafting (CABG) has been
considered the gold standard treatment for coronary disease1,2. CABG has good outcomes 3because of complete revascularization (CR) and good graft patency.
Off-pump CABG (OPCAB) was shown in a randomized trial4 and retrospective analysis 5 to
have the same advantages as on-pump CABG while avoiding the morbidities
associated with blood–machine interactions. However, these approaches
are potentially associated with surgical invasiveness involving the
sternum and wound complications. In the era of minimally invasive
surgery, patients prefer durable outcomes and less invasiveness, which
help them to recover their normal activity. Minimally invasive coronary
surgery–CABG (MICS CABG) via left anterior thoracotomy is reportedly a
less invasive and sternum-sparing approach for multivessel or left main
artery disease 6-9. Unlike CABG via sternotomy, which
has been studied for many years with convincing data showing its
effectiveness and reproducibility, fewer objective data are available
for MICS CABG, especially angiographic data regarding the graft patency
and CR rates 10-12.
In MICS CABG, limited space for visualization and heart manipulation
adds technical difficulty when constructing anastomoses to the lateral
or post-inferior epicardial vessels 13. This might be
associated with impaired graft patency and incomplete revascularization
(ICR). After adopting OPCAB and minimally invasive direct CABG as
routine practice for surgical revascularization, we transformed our
practice to MICS CABG for multivessel and left main artery disease. Our
preliminary experience made it possible to revascularize target vessels
with a left internal thoracic artery (LITA) and sequential saphenous
vein (SV) graft via minimal thoracotomy. In the present study, we
analyzed
a series of 186 consecutive patients who underwent MICS CABG with a
focus on the postoperative graft patency and CR rates.