BACKGROUND: We have started MICS CABG from 2012 and have shared our technique with another surgeon from 2015. We would like to share our results of MICS CABG of our group and assess to use a right gastro-epiploic artery (RGEA) can be a standard graft strategy in MICS CABG. METHODS: Between February 2012 and July 2023, 356 cases of minimally invasive coronary artery bypass grafting (MICS CABG) via a left thoracotomy were done by three experienced surgeons, of which 61 cases used a RGEA were reviewed retrospectively. Our strategy of MICS CABG is off pump and complete revascularization using multi arterial grafts based on BITA under direct vision. RGEA was harvested via upper abdominal 6 cm incision using Harmonic scalpel (Ethicon, USA). RESULTS: Multi vessel MICS CABG was performed in 60 cases. Average ejection fraction was 56 %, 12 cases was on hemodialysis. Average distal anastomosis was 3.1. BITA was used in 40 cases, Radial artery was used in 11 cases. Multi arterial grafting and an-aortic manner were done in 60 cases and total arterial grafting and complete revascularization were done in 58 cases. There were three cases of using CPB and no conversion to sternotomy. There was no two stroke dure to plaque rupture and no mortality. Early graft patency was 60/61. DISCUSSION: A RGEA was used in cases of particularly severe stenosis (99-100%) of the right coronary artery and the patency rate was 98%, which was satisfactory. The use of RGEA resulted in multiple arterial grafts in 98% of cases, which can be expected to contribute to long-term prognosis. 2 cases of cerebral infarction were fortunately mild, regardless of the procedure. BITA was used in 66% of cases, so MICS CABG can use BITA and GEA at the same time without concern for deep sternal wound infection. CONCLUSION: Clinical result of off-pump MICS CABG with RGEA was satisfactory. The RGEA can be an important graft in MICS CABG. This approach has the potential for further optimization with revascularization strategies for experienced surgeon.
