[Perioperative results of minimally invasive direct artery bypass grafting (MIDCAB) in treatment of patients with ischemic heart disease: 1366 operated patients]

Abstract

Objective: To study perioperative results of minimally invasive direct coronary artery bypass grafting (MIDCAB) off-pump in treatment of patients with ischemic heart disease (IHD).

Patients and methods: Our retrospective single-center study included a total of 1366 patients operated on during the period from September 2012 to September 2024 at the Federal State Budgetary Institution 'Federal Center for High Medical Technologies' (Kaliningrad). All patients underwent coronary bypass grafting (CBG) of the anterior descending artery (ADA) according to the MISCAB technique. There were 1054 (77.1%) men and 312 (22.9%) women. The mean age of the patients amounted to 66.1±16.4 years. Prior to surgery, functional class II angina of effort was diagnosed in 422 (30.9%) patients and FC III angina in 811 (59.4%) patients. 865 (63.3%) patients had a history of myocardial infarction. Lesions of the brachiocephalic arteries were detected in 194 (14.2%) patients and lesions of the low-limb arteries in 188 (13.7%) patients. 701 (51.3%) patients underwent hybrid interventions and 14 (1%) were subjected to subclavian coronary artery bypass grafting. Risk stratification was assessed by the EuroSCORE scale, amounting to 2.2±1.1%. We analyzed such perioperative parameters as early mortality, postoperative complications, and the immediate results.

Results: All 1366 patients underwent CABG via left anterolateral thoracotomy off-pump (MIDCAB). Of these, in 701 patients CABG was performed as a stage of hybrid intervention. The average length of stay in intensive care unit and that of hospital stay amounted to 1.1 and 6.1 days, respectively. The early postoperative period in 17 (1.2%) patients was complicated by hemorrhage, requiring wound revision. 32 (2.3%) patients developed cardiac arrhythmia as atrial fibrillation relieved medicamentally. Surface suppuration of the postoperative wound occurred in 9 (0.7%) patients. The in-hospital mortality rate amounted to 0.7% (9 patients).

Conclusion: The MIDCAB technique is feasible 'on stream' and is associated with satisfactory immediate results in treatment of CAD patients of various age categories, with severe accompanying pathology, as well as in repeat patients. MIDCAB can be used in both an isolated lesion of the ADA and in a multi-vessel lesion as a stage of hybrid intervention. For further study of the technique, it is necessary to conduct prospective randomized trials and to examine long-term results.

Keywords: MIDCAB; anterior descending artery; coronary bypass angiography; left-sided mini-thoracotomy.