Safety and Clinical Outcome of Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Procedure in 234 Patients

Background: The popularity of minimally invasive approach in cardiac surgery is increasing. Minimally invasive direct coronary artery bypass (MIDCAB) is a less traumatic surgical technique and offers a solution for revascularization of left anterior descending (LAD) and is also an option for hybrid revascularization procedure in multivessel disease.

Method: From 2017 to 2021, a total of 234 patients underwent MIDCAB procedure in our heart center. 27% were female. The majority of patients had two or three vessel disease (75%). Patients’ mean age was 66 ± 12 years. The left internal mammary artery (LIMA) was anastomosed to the left anterior descending via left minithoracotomy approach in all patients. Multivessel MIDCAB with two anastomoses (additional saphenous vein graft as T-graft to LIMA) was performed in 35 patients (15%).

Results: Mean operation time was 2.3 ± 0.8 hours. The 30-day mortality was 1.7% (n = 4). The applied amount of packed red blood cells (pRBC) was 0.4 ± 0.8 unit. The average intensive care unit stay (ICU) was 1 ± 1.2 day. We observed wound infections in three patients (1.3%) postoperatively. One patient (0.4%) presented with a minor stroke postoperatively. Myocardial infarction was observed in two patients (0.9%) who underwent coronary re-angiography perioperatively and stent therapy of the right coronary artery.

Conclusion: MIDCAB for selected patients with proximal LAD lesions or as a hybrid procedure in multivessel disease is a safe procedure with a low 30-day mortality and good clinical outcome. Intra- and perioperative application of pRBCs and ICU stay is low. The trauma and incision is small with a good cosmetic result. However, long-term clinical follow-up data are necessary to strengthen our thesis.

Publication History

Article published online:
03 February 2022