Minimally Invasive Multivessel CABG: a Modern Option to OPCAB Surgery

  • #AC/COR 02-O-9
  • Adult Cardiac Surgery/Coronary. SESSION-2
  • Oral

Minimally Invasive Multivessel CABG: a Modern Option to OPCAB Surgery

Mikhail Snegirev 1, Artem Paivin 1, Dmitry Denisyuk 1, Nikolai Khvan 1, Lana Sichinava 1, Vladimir Sharafutdinov 2, Andranik Tatoyan 1, Oleg Paivin 2

City hospital 40, Saint-Petersburg, Russia; Sokolov hospital of FMBA Russia, Saint-Petersburg, Russia;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–A



Minimally invasive CABG (MICS-CABG) is a multivessel myocardial revascularization procedure performed via left-side minithoracotomy. Growing interest to MICS-CABG arises on current safety and reproducibility evidence and promising long-term data. We report our initial MICS-CABG experience performed via off-pump approach.


Since august 2014 204 patients underwent MICS-CABG through 8-10 cm 4-5 intercostal space left-side minithoracotomy. LIMA graft was harvested in routine MIDCAB fashion, saphenous vein was harvested endoscopically, and proximal anastomoses were performed with aortic side-clamp and long-shaft instruments. Distals were performed with routine OPCAB vacuum stabilizers, placed through the wound orifice, and full revascularization was achieved in all cases. Perioperative data was collected, and 3-year results are upcoming.


Mean patient age was 63.9+9.3 years. Most patients were men (61.8%). Mean left ventricle EF was normal (50.7+7.3%). 17.6% had left main stenosis and 26.5% had diabetes mellitus (DM). There was no perioperative mortality. Almost all procedures were performed via off-pump approach (1 case (0.5%) with femoral CPB). Mean number of grafts performed was 2.6±0.9 with median (51.5%) of 3 grafts. In 2 cases (1.0%) conversion to sternotomy and CPB was done due to hemodynamic instability. Mean operative time was 201.5+33.5 min and mean drainage loss was 196.3+88.4 ml. Major postoperative bleeding, requiring reopening was in 1.5% of cases and rate for both MI type V and stroke was 0.5%. In 8 cases (3.9%) wound infection requiring specific treatment was noted.


Familiarizing with conventional OPCAB surgery is a critical step to traverse MICS-CABG learning curve. One should not consider MICS-CABG a substitute to conventional OPCAB, but a likely tool to simplify selection in some categories of high risk patients. Promoting wider acceptance to OPCAB may support current trend to minimize surgical trauma, thus extending availability for CABG.

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