Minimally invasive coronary artery bypass grafting with ultrasonically skeletonized internal thoracic artery

Kazutoshi Tachibana; Keita Kikuchi; Kouhei Narayama; Akihito Okawa; Yu Iwashiro; Ayaka Arihara; Akihiko Yamauchi

doi:10.1016/j.xjtc.2022.05.010

Minimally invasive coronary artery bypass grafting with ultrasonically skeletonized internal thoracic artery

JTCVS Tech. 2022 May 18:14:107-113. doi: 10.1016/j.xjtc.2022.05.010. eCollection 2022 Aug.

Authors

Kazutoshi Tachibana¹, Keita Kikuchi², Kouhei Narayama², Akihito Okawa¹, Yu Iwashiro¹, Ayaka Arihara¹, Akihiko Yamauchi²

Affiliations

¹ Department of Cardiovascular Surgery, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan.
² Department of Cardiovascular Surgery, Yuuai Medical Center, Tomishiro, Okinawa, Japan.

Abstract

Objective: This study aimed to examine the feasibility and safety of minimally invasive cardiac surgery coronary artery bypass grafting using an ultrasonically skeletonized internal thoracic artery in the authors' initial experience.

Methods: From February 2012 to May 2021, 247 consecutive patients who underwent minimally invasive coronary artery bypass grafting using an ultrasonically skeletonized internal thoracic artery were reviewed retrospectively. Internal thoracic arteries were harvested in a full skeletonized fashion using an ultrasonic scalpel via left minithoracotomy. Bilateral internal thoracic arteries were used in 108 patients, and the internal thoracic arteries as in situ grafts were used in 393 anastomoses. Total arterial revascularization was performed in 126 patients, and 142 patients underwent aortic nontouch minimally invasive coronary artery bypass grafting.

Results: The patients' mean (range) age was 65.9 ± 11.5 (30-90) years. The mean (range) number of anastomoses performed was 2.6 ± 1.1 (1-6). Forty-six patients (18.6%) had 4 grafts, 94 patients (38.1%) had 3 grafts, and 60 patients (24.3%) had 2 grafts. Minimally invasive coronary artery bypass grafting was completed without conversion to sternotomy in all patients. Cardiopulmonary bypass was performed in 3 patients (1.2%), reinterventions due to bleeding were performed in 7 patients (2.8%), and chest wound infections were observed in 5 patients (2.0%). There was 1 (0.4%) mortality.

Conclusions: Minimally invasive coronary artery bypass grafting using an ultrasonically skeletonized internal thoracic artery is feasible and has shown good perioperative outcomes. This approach has the potential for further optimization with revascularization strategies.

Keywords: BITA, bilateral internal thoracic artery; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; CT, computed tomography; GEA, gastroepiploic artery; Harmonic scalpel; ICS, intercostal space; ITA, internal thoracic artery; LAD, left anterior descending; LITA, left internal thoracic artery; MICS CABG, minimally invasive cardiac surgery coronary artery bypass grafting; MID CABG, minimally invasive direct coronary artery bypass; OPCAB, off-pump coronary artery bypass; RA, radial artery; RITA, right internal thoracic artery; coronary artery bypass grafting; minimally invasive cardiac surgery; minimally invasive coronary artery bypass grafting; skeletonized internal thoracic artery.