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Foundation Of The Minimally Invasive Coronary Surgery Program In The Context Of A Developing Country: A Single-center Experience
Dmitry Turliuk
1,
Nikita Konovalov1, Vasily Li
1, Anton Khilchuk
2, Abdumalik Yuldoshev
1.
1'Ezgu Niyat' medical centre, Tashkent, Uzbekistan,
2Shox International Hospital, Tashkent, Uzbekistan.
OBJECTIVE: Minimally invasive coronary artery bypass grafting (MICS CABG) is well-established in high-resource settings due to its benefits in postoperative recovery and reduced surgical trauma. However, its implementation in developing countries remains limited. This study presents the three-year experience of initiating a MICS CABG program in a private hospital in Uzbekistan, focusing on clinical outcomes, implementation challenges, and viability within a self-sponsored healthcare environment.
METHODS: Between January 2023 and March 2025, a total of 53 patients (42 men and 11 women) underwent MICS CABG via left anterior mini-thoracotomy. Preoperative selection was rigorous due to institutional constraints, including limited ICU monitoring capabilities, occasional resistance from the anesthesiology team, and the strategic need for early rehabilitation and discharge. Of the procedures performed, 27 patients received a minimally invasive direct coronary artery bypass (MIDCAB) with the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). 14 patients underwent dual arterial grafting with LIMA to LAD and Radial artery to the diagonal branch. The remaining 12 patients received three bypass grafts using LIMA, Radial artery, and Saphenous vein. Outcomes from this group were compared with the cohort of conventional CABG via sternotomy.
RESULTS: Patients in the MICS CABG group had an average ICU stay of 1.7 days, which was comparable to the 1.8-day stay observed in the sternotomy group. However, the total hospital stay was significantly shorter in the MICS group, averaging 7.5 days compared to 9.7 days in the conventional group. Postoperative complications were also fewer in the MICS cohort, with no cases requiring reintervention or intra-operative conversion to sternotomy. There were no mortalities in the MICS group within the 30-day postoperative period.
CONCLUSIONS: Our experience confirms the feasibility and safety of implementing a MICS CABG program in a developing country, despite infrastructural and systemic limitations. Comparable ICU outcomes, shorter hospital stays, and reduced complication rates highlight the clinical value of MICS in resource-limited settings. This model may serve as a reference for similar institutions aiming to modernize cardiac surgery services and further development of training for long-term sustainability.
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