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Pushing The Limits Of Minimally Invasive Off-pump Cabg: A Case Series Of Quadruple And Quintuple Bypass, Total Arterial Revascularization
Danko Grujic.
Clinic for cardiac surgery, Belgrade, Serbia.
OBJECTIVE:This case series demonstrates off-pump minimally invasive coronary bypass grafting in a patient with multivessel coronary artery disease, as a clinically good substitute for conventional CABG. All operations were performed without manipulating the ascending aorta, and complete surgical revascularization of the myocardium was achieved with only arterial grafts.
METHODS:During one year from Januar 2024 until March 2025, a total of 10 patients underwent off-pump MICS CABG in multivessel disease. A quadruple bypass grafting was performed in seven patients, and in three cases, a quintuple bypass was done. Surgical revascularization was achieved using the left and right internal mammary artery, radial artery, and right gastroepiploic artery. The construction of anastomosis was in T and sequential graft configurations. Standard exposure was used in this procedure, with single or double shunt techniques.
RESULTS:This study included 10 male patients average age of 68.75 years. Operative time was 250 min to 320 min. The average period of ICU stay was 2.20 days, and the patients were discharged from the hospital on 4.30 days in a hemodynamically stable state. Three months after the operation, on the conatrol re-coronarography, all grafts showed optimal flow, and the patients were without complication or major adverse cardiac event
CONCLUSIONS:Through the lens of minimally invasive surgery, access to non-touch aorta and off-pump effectively reduces the numerous complications. Furthermore, reducing surgical trauma results in improved patients' quality of life, shortens hospital stays, and emphasizes economic benefits. Total arterial revascularization of myocardium through lateral thoracotomy demands a sophisticated learning curve, but this concept is realizable in multivessel disease.
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