Minimally Invasive Coronary Bypass Grafting as a Standard Approach for Myocardial Revascularization

Keywords: coronary artery disease, coronary artery bypass, minimally invasive coronary artery bypass grafting


Background. Minimally invasive cardiac surgery is becoming more widespread.

The aim of the study was to evaluate the outcomes in 343 consecutive patients with isolated multivessel coronary artery disease who underwent minimally invasive coronary revascularization.

Materials and methods. From July 2017 to December 2019 we performed total coronary revascularization via left anterior minithoracotomy (TCRAT) in 343 consecutive patients with isolated multivessel coronary artery disease. In 83 (24.2%) of them we performed multiarterial revascularization using left internal mammary artery (LIMA) and T-shunt with left radial artery or right internal mammary artery (RIMA). Cardiopulmonary bypass (CPB), aortic cross-clamping and blood cardioplegia were used in all patients. The patients were divided into two groups, uniarterial and multiarterial, to compare and analyze perioperative parameters.

Results. No cases of postoperative myocardial infarction, surgically induced infection, or conversion to sternotomy were observed in any of the study groups. Total perioperative mortality was 0.58% (2 patients). Total operation time (290.6±48 [205; 495] versus 259.4±53.3 [165; 590], p=0.0001) and aortic cross-clamping time (81.6±18.7 [40; 122] versus 67±18 [35; 146], p<0.0001) were longer in patients with multiarterial revascularization compared to those with uniarterial revascularization. The patient’s mean age in the multiarterial group was 7.4 years less than in the uniarterial group. The mean hospital stay was 0.5 days shorter in the multiarterial group.

Conclusions. The technique of minimally invasive coronary artery bypass grafting via left anterior thoracotomy avoids median sternotomy in 97.7% of patients. Both strategies for minimally invasive myocardial revascularization (multiarterial and uniarterial) are safe and effective with comparable perioperative outcomes and a total mortality of 0.58%.


  1. McGinn JT Jr, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation. 2009;120:S78–S84.
  2. Head SJ, Kieser TM, Falk V, Huysmans HA, Kappetein AP. Coronary artery bypass grafting: Part 1--the evolution over the first 50 years. European Heart Journal. 2013;34(37):2862–72.
  3. Kikuchi K, Mori M. Minimally invasive coronary artery bypass grafting: a systematic review. Asian Cardiovasc Thorac Ann. 2017;25:364–70.
  4. Rodriguez M, Ruel M. Minimally invasive multivessel coronary surgery and hybrid coronary revascularization: can we routinely achieve less invasive coronary surgery? Methodist Debakey Cardiovasc J. 2016;12(1):14–9.
  5. Nambiar P, Mittal C. Minimally invasive coronary bypass using internal thoracic arteries via a left minithoracotomy: “The Nambiar Technique”. Innovations (Phila). 2013;8:420–6.
  6. Grossi EA, Groh MA, Lefrak EA, Ribakove GH, Albus RA, Galloway AC, et al. Results of a prospective multicenter study on port-access coronary bypass grafting. Ann Thorac Surg. 1999;68:1475–7.
  7. Gulielmos V, Brandt M, Knaut M, Cichon R, Wagner FM, Kappert U, et al. The Dresden approach for complete multivessel revascularization. Ann Thorac Surg. 1999;68:1502–5.
  8. Dogan S, Aybek T, Andressen E, Byhahn C, Mierdl S, Westphal K, et al. Totally endoscopic coronary artery bypass grafting on cardiopulmonary bypass with robotically enhanced telemanipulation: report of forty-five cases. J Thorac Cardiovascular Surg. 2002;123:1125–31.
  9. Subramanian VA, Patel NU, Patel NC, Loulmet DF. Robotic assisted multivessel minimally invasive direct coronary artery bypass with port-access stabilization and cardiac positioning: paving the way for outpatient coronary surgery? Ann Thorac Surg. 2005;79:1590–6.
  10. Babliak O, Demianenko V, Melnyk Y, Revenko K, Pidgayna L, Stohov O. Complete Coronary Revascularization via Left Anterior Thoracotomy. Innovations (Phila). 2019;14(4):330–41.
  11. Babliak OD, Demianenko VM, Melnyk EA, Revenko KA, Pidhayna LV, Stohov OS. [Miniinvasive multivessel coronary grafting through left anterior thoracotomy]. UMJ Heart & Vessels. 2018;(1):65–9. Ukrainian.
  12. Babliak O, Demianenko V, Babliak D, Melnyk E, Revenko K, Stohov OS. Innovative Approach – Minimally Invasive Multivessel Coronary Grafting Through a Left Anterior Thoracotomy. Proceedings of the Shevchenko Scientific Society Medical Sciences. 2019;55(1):65–76.
  13. Demianenko VM, Babliak OD, Babliak DY, Stohov OS, Melnyk EA, Revenko KA, et al. [Features of Cardiopulmonary Bypass in Mininvasive Multivessel Coronary Artery Bypass Grafting]. Ukrainian journal of cardiovascular surgery. 2019;(2):18–22. Ukrainian.
How to Cite
Babliak, O. D., Demianenko, V. M., Babliak, D. Y., Marchenko, A. I., Melnyk, E. A., & Stohov, O. S. (2020). Minimally Invasive Coronary Bypass Grafting as a Standard Approach for Myocardial Revascularization. Ukrainian Journal of Cardiovascular Surgery, (2 (39), 9-14.

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