Back to 2025 Cardiac Abstracts
Total Coronary Revascularization Via Left Anterior Thoracotomy As A Standard Approach
Oleksandr Babliak,
Dmytro Babliak, Serhii Yatsuk.
Diagnostic and Treatment Center for Children and Adults, Dobrobut Medical Network, Kyiv, Ukraine.
BACKGROUND:To analyze the outcomes of multivessel minimally invasive coronary revascularization performed via left anterior minithoracotomy as a standard approach.
METHODS:Between July 2017 and November 2024, 772 consecutive patients with isolated multivessel coronary artery disease underwent surgical revascularization. Left anterior minithoracotomy was used in 761 patients (98.6%). The mean patient age was 62.8 ± 9.4 years (range: 31-90), mean body surface area - 2.0 ± 0.2 m² (range: 1.5-2.7) and mean left ventricular ejection fraction - 51.4 ± 9.2% (range: 15-70). Peripheral cardiopulmonary bypass (CPB), a Chitwood clamp, and intermittent blood cardioplegia were used in all cases. Conventional coronary instruments were utilized. Conduits included the left internal mammary artery (96.7%), right internal mammary artery (1.4%), radial artery (29.3%), and saphenous vein (86.3%). All distals anastomoses and T-shunts, if needed, were performed on the arrested heart and the majority of proximal anastomoses were performed with a side-biting clamp
RESULTS:Hospital mortality was 0.3%. No conversions to sternotomy was needed. A total of 2289 distal coronary anastomoses and 1035 proximal aortic anastomoses were performed, along with 166 T-shunts. The mean number of distal anastomoses per patient was 3 ± 0.7 (range: 2-5). The mean aortic cross-clamp time was 73.5 ± 20 minutes (range: 31-168), CPB time was 151.6 ± 35.7 minutes (range: 71-296), and total operation time was 278.5 ± 53.1 minutes (range: 190-495). Patients had an average hospital stay of 6 ± 1.9 days (range: 3-20).
CONCLUSIONS:Multivessel coronary artery bypass grafting via left anterior minithoracotomy with CPB and cardioplegia according to TCRAT technique utilized as a standard approach can result in the excellent perioperative outcome and 98.6% of patients can benefit from sternum-sparing surgery. Future progress should focus on more frequent use of arterial grafts.
Back to 2025 Cardiac Abstracts
