Additional right-sided upper “Half-Mini-Thoracotomy” for aortocoronary bypass grafting during minimally invasive multivessel revascularization

BACKGROUND Although minimally invasive coronary artery bypass grafting (MICS-CABG) has been shown to result in excellent clinical outcomes overall adoption rates still remain low. Traditional strategies for minimally invasive multivessel revascularization - usually performed through single-thoracotomy - have to deal with restricted grafting possibilities and possible increased susceptibility of arterial grafts to competitive flow, restraining their applicability to very specific indications or hybrid approaches and on top, are prone to conversion to full-sternotomy in case of left internal thoracic artery (LITA) insufficiency. METHODS Here, we present a novel alternative to the traditional MICS-CABG approaches by adding a right-sided upper "half-mini-thoracotomy", which allows for aortocoronary bypass grafting in standard "off-pump" manner and adoption of similar revascularization principles as with conventional CABG during minimally invasive multivessel revascularization, though reducing restrictions inherent to current MICS-CABG strategies. RESULTS So far, feasibility and safety of this new approach has been successfully shown in 7 consecutive patients requiring surgical revascularization with no procedure-specific complications and graft configuration as well as intraoperative flow assessment comparable to those of similar patients operated via standard full-sternotomy off-pump coronary artery bypass (OPCAB) surgery. CONCLUSIONS Further evaluation warranted, this technique might have the potential to develop into an additional approach for minimally invasive multivessel revascularization, especially in cases where competitive flow to arterial grafts is feared, while also serving as a bailout-strategy for traditional approaches in case of LITA insufficiency.