Minimally Invasive Coronary Revascularization. Technical Aspects and Current Results

Abstract

Coronary artery bypass surgery has been for decades the gold standard for the treatment of coronary artery disease, especially in patients with 3-vessel disease. Despite the excellent results achieved through the application of this technique, problems related to median sternotomy and the use of cardiopulmonary bypass such as wound infections and cerebral stroke still play an important role in the postoperative course of these patients. Minimally invasive coronary revascularization techniques aim at reducing the rate of such complications while offering the same quality of revascularization. Minimally invasive coronary surgery includes a set of coronary revascularization techniques that are completed without the use of cardiopulmonary bypass or through a left mini-thoracotomy at the level of the 4th or 5th intercostal space and aim at reducing the level of the aforementioned complications compared to the standard technique. Hybrid coronary revascularization is an alternative approach that combines surgical revascularization with percutaneous coronary interventions to extend the treatment spectrum even further. Through the application of these techniques, surgeons aim at minimizing the risk of infection of the surgical wound and significantly reduce the number of post-operative cerebral strokes. Also, numerous studies have shown that minimally invasive coronary surgery can offer better results in terms of duration of the mechanical ventilation, length of stay in intensive care, transfusions of blood products and consequently in reducing treatment costs. Minimally invasive revascularization techniques are not only an important alternative to standard coronary surgery, but in the near future will constitute the standard treatment for this group of patients. This article aims to describe the techniques used to achieve minimally invasive coronary revascularization and to highlight the outcomes of the different approaches.CABG,