From OPCAB to MIDCAB to Multi-vessel MIDCAB. Establishing a Minimally Invasive Coronary Artery Bypass Program: Initial Experiences of an Academic Center

Background: With minimally invasive direct coronary artery bypass (MIDCAB) coronary artery bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB) and sternotomy. Therefore, we established a step-by-step approach from off-pump coronary artery bypass (OPCAB) to MIDCAB and finally to multivessel (MV-) MIDCAB surgery. Here, we report our experience with this stepwise approach.

Methods: We studied the in-hospital records of 147 consecutive patients treated with OPCAB, MIDCAB, and MV-MIDCAB surgery at our department from March 2021 to March 2023. Preoperative demographic characteristics, co-morbidities and risk factors were analyzed. We also looked at procedural parameters such as the duration of surgery time and the numbers of bypass grafts and analyzed postoperative rates of complications. The length of stay in the ICU and the total hospital stay were calculated for all patients.

Results: OPCAB, MIDCAB and MV-MIDCAB were performed in 106/147, 29/147 and 12/147, respectively. The Median (range) age (years) was 71 (45–88), 67 (43–85) and 76 (61–82) and the median (range) body mass index (kg/m²) was 27 (19–52), 28 (19–38) and 29 (24–39) in OPCAB, MIDCAB and MV-MIDCAB, respectively. The mean duration time of surgery (min) was 230 ± 55, 207 ± 38, 244 ± 55 and the mean number of grafts was 2.6, 1.0, 2.1 in OPCAB, MIDCAB and MV-MIDCAB, respectively. One patient was converted to CPB in the OPCAB and one patient was converted to sternotomy in the MIDCAB group. Two Patients underwent re-exploration for bleeding in the OPCAB group. Repeat revascularization did not occur in any group. One patient (OPCAB group) died within the first 30 days. Median (range) ICU stay (hours) was 21(6–166), 20(6–162), 20(13–98) and median (range) total hospital stay (days) was 9 (6–30), 8 (5–26), 9 (7–14) in OPCAB, MIDCAB and MV-MIDCAB, respectively.

Conclusion: Minimally invasive coronary bypass surgery without the use of CPB and sternotomy is a feasible and safe procedure. Our data demonstrate that a minimally invasive coronary bypass program can be established stepwise in an academic center for cardiac surgery with good early results. Therefore, we recommend this gradual approach when such a goal is intended.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024