Abstract 2280: Three Hundred Consecutive Cases of Multi-Vessel Small Thoracotomy (MVST) Coronary Artery Bypass Grafting
Background: Multi-Vessel Small Thoracotomy (MVST) is a new coronary operation that does not require special infrastructure and is potentially available to all cardiac surgeons. It aims at approaching the minimal invasiveness of percutaneous coronary interventions (PCI) while giving patients the durability of surgical revascularization. We examined the feasibility and safety of MVST in the first large series of this operation to date.
Methods and Results: All myocardial territories can be accessed via a 4 – 6cm left 5th intercostal (IC) thoracotomy. An endothoracic apical retractor and epicardial stabilizer are introduced through the subxyphoid and left 7th IC spaces, respectively. The procedure is performed off-pump. The left internal thoracic artery (LITA) is used to graft the left anterior descending (LAD), and radial artery or saphenous vein segments are used to graft the lateral and inferior myocardial territories. Proximal anastomoses are performed from the LITA as a T-graft or directly on the aorta. In the first 300 consecutive MVSTs at our 2 centers, mean age was 61.9±10.7y and 97 patients were female (32%). Diabetes was prevalent in 94 (31%) and previous PCI in 69 (23%). The average number of grafts was 2.1±0.8; 104 patients (34%) had total arterial grafting, and 7 (2.3%) underwent MVST as a hybrid revascularization strategy. There were 12 conversions to sternotomy (4.0%), 7 patients requiring CPB assistance (2.3%), and 3 reinterventions for bleeding (1.0%). Perioperative mortality was 2 patients (0.7%). Respiratory failure occurred in 22 patients (5.3%), atrial fibrillation in 52 (17%), and the median length of stay was 4 days. No stroke or deep wound infection occurred. At a mean follow-up of 19.2±9.4 months, 9 patients (3.0%) had required postoperative coronary interventions, 7 of which were for issues with LITA T-grafts. Only 2 graft failures occurred in the 128 patients with proximal anastomoses onto the aorta (P=0.1 vs. LITA T-grafts).
Conclusions: MVST is feasible, safe, and associated with excellent procedural and short-term outcomes. The avoidance of T-grafts from the LITA may optimize long-term patency. The MVST procedure has the potential to make multi-vessel minimally invasive coronary surgery safe, effective, and diffusible.