Advantages of Minimally Invasive Coronary Artery Bypass Grafting in Wartime Conditions

Abstract

Minimally invasive direct coronary artery bypass (MIDCAB) is a promising surgical method for myocardial revascularization in coronary artery disease, performed via a mini-thoracotomy without cardiopulmonary bypass. In wartime conditions, the application of minimally invasive technologies gains special significance due to the need to optimize the use of limited resources, reduce blood loss, and shorten rehabilitation time. MIDCAB enables effective revascularization with minimal surgical trauma, which is critically important for military personnel requiring rapid functional recovery.

Aim. To justify the feasibility of implementing minimally invasive coronary artery bypass technologies to improve myocardial revascularization outcomes under resource-limited conditions during military operations.

Materials and Methods. The study included 42 patients divided into two groups: the main group (mini-access) – 16 patients (100 % military personnel) who underwent coronary artery bypass through a mini-lateral approach, and the control group (sternotomy) – 26 patients who underwent traditional CABG through median sternotomy. All operations in the main group were performed on the beating heart (off-pump). Analysis of intraoperative and postoperative parameters was conducted.

Results. The minimally invasive approach was associated with a statistically significant reduction in intraoperative blood loss (140±17 ml vs. 200±50 ml, p=0.041), need for blood transfusion (6.2 % vs. 30.8 %, p=0.048), duration of mechanical ventilation (3.5±1.2 h vs. 6.5±2.8 h, p=0.001), ICU stay (1.0±0.2 days vs. 2.2±0.9 days, p<0.001), and total hospitalization (9.2±3.5 days vs. 13.8±5.2 days, p=0.003). The rate of postoperative complications was statistically significantly lower with the mini-access approach (6.2 % vs. 42.3 %, p=0.015). In wartime conditions, the off-pump MIDCAB technique allows procedures to be performed during power outages and in hospitals without full-service cardiac surgery departments, which is critical for decentralizing specialised care. Additionally, the reduced need for blood products preserves limited supplies for patients with massive combat trauma. No hospital mortality was observed in either group.