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International Society For Minimally Invasive Cardiothoracic Surgery

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Clinical Outcome Of Off Pump Minimally Invasive Coronary Artery Bypass Grafting With Bilateral Internal Thoracic Arteries
Keita Kikuchi, Akihiko Yamauchi, Kouhei Narayama, Kouji Iha, Masataka Koga, Nobuhiro Shimabukuro.
Yuuai Medical Center, Tomishiro, Japan.

BACKGROUND:Minimally invasive coronary artery bypass grafting (MICS CABG) was introduced in 2009 and have growth surely. Several report also introduced the results of MICS CABG using SITA + vein grafts. Arterial grafts, especially usage of bilateral internal thoracic arteries (BITA) are not common in MICS CABG. We have started using BITA in MICS CABG from 2014. Herein we present our outcomes of off pump MICS CABG using BITA. The purpose of this study is to demonstrate how to use BITA in MICS CABG. METHODS: Multi vessel off pump MICS CABG was performed in consecutive 203 cases out of 246 cases, between February 2012 and August 2021. Of them 110 cases which were used BITA in this cohort were evaluated retrospectively.After established surgical field for MICS CABG, a 32cm harmonic scalpel was used to harvest ITAs. Then, proximal and distal anastomoses were done using same method we reported previously. We intend to use right internal thoracic artery (RITA) as an in-situ graft to the left anterior descending artery (LAD) in MICS CABG. RESULTS:Mean age was 63.7. Average number of distal anastomoses was 3.3 and length of surgery was 337.0 minutes. RITA was used as an in-situ graft in 74 cases (67.3%) and as a composited graft in 36 cases (32.7%, Y-:15 cases, I-: 15 cases, V-: 6 cases). There was no cases of on pump conversion and sternotomy. An aortic strategy was performed in 79 cases (71.8%). Total re-vascularization was achieved in 92 cases (86.8%) except scheduled hybrid strategy (4 cases). All arterial grafting was performed in 57 cases (51.8%). There was no stroke, no deep sternal wound infection and no mortality. CONCLUSIONS:MICS CABG using BITA can be feasible and safe procedure with standard graft configuration like a conventional CABG. It will also provide an-aortic and total arterial graft strategy. MICS CABG using BITA may offer the long-term benefits without deep sternal wound infection. Generalization of this technique will be the key to open the door.


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