Nonsternotomy multivessel coronary artery bypass grafting: A key development in cardiac surgery

摘要

Central MessageThe CABG operation of the future must be safe, effective, and durable while less invasive and widely applicable. Nonsternotomy multivessel CABG is an important step in that direction.See Commentary on page 168. The CABG operation of the future must be safe, effective, and durable while less invasive and widely applicable. Nonsternotomy multivessel CABG is an important step in that direction. See Commentary on page 168. In the 1990s and early 2000s, attempts at performing less-invasive coronary artery bypass grafting (CABG) were largely restricted to the minimally invasive direct coronary artery bypass operation, itself a variation of the first CABG operation performed—in 1964 and through a thoracotomy—by Kolesov and Potashov.1Kolesov V.I. Potashov L.V. Surgery of coronary arteries.Eksp Khir Anesteziol. 1965; 10 ([in Russian]): 3-8PubMed Google Scholar With the exception of multiple anterior target coronary vessels and other rare favorable combinations, multivessel bypass grafting through a nonsternotomy incision was not considered feasible until a large consecutive patient series was published in 2009.2McGinn Jr., J.T. Usman S. Lapierre H. Pothula V.R. Mesana T.G. Ruel M. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients.Circulation. 2009; 120: S78-S84Crossref PubMed Scopus (126) Google Scholar These minimally invasive (MICS) CABG data became a catalyst for the adoption, over the ensuing decade, of this operation at other expert centers in America, Asia, Europe, and Oceania. Nowadays, it is estimated that thousands of MICS CABGs are performed every year. Nevertheless, multivessel MICS CABG remains a technically challenging operation performed only at select centers. Complete ease of the surgeon and team at off-pump coronary artery bypass (OPCAB) represents 1 prerequisite, after which surgeons should initiate single-vessel MICS CABG to the left anterior descending artery, performed either conventionally or with robotic assistance. Numerous training programs and peer-to-peer options exist for surgeons and teams who wish to learn and develop MICS CABG. The outcomes of this operation have also been validated by several groups, and data pertaining to its safety, feasibility, adoptability, angiographic patency of grafts and, as of recently, long-term durability, are now available.3Lapierre H. Chan V. Sohmer B. Mesana T.G. Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study.Eur J Cardiothorac Surg. 2011; 40: 804-810PubMed Google Scholar, 4Une D. Lapierre H. Sohmer B. Rai V. Ruel M. Can minimally invasive coronary artery bypass grafting be initiated and practiced safely? A learning curve analysis.Innovations (Phila). 2013; 8: 403-409Crossref PubMed Scopus (29) Google Scholar, 5Ruel M. Shariff M.A. Lapierre H. Goyal N. Dennie C. Sadel S.M. et al.Results of the minimally invasive coronary artery bypass grafting angiographic patency study.J Thorac Cardiovasc Surg. 2014; 147: 203-208Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 6Guo M.H. Vo T.X. Horsthuis K. Rahmouni K. Chong A.Y. Glineur D. et al.Durability of minimally invasive coronary artery bypass grafting: 10-year outcomes in 510 consecutive patients.J Am Coll Cardiol. 2021; 78: 1390-1391Crossref PubMed Scopus (1) Google Scholar A randomized clinical trial comparing multivessel surgical revascularization by MICS CABG versus regular sternotomy has, as of this writing, completed nearly one half of its recruitment.7Guo M.H. Wells G.A. Glineur D. Fortier J. Davierwala P.M. Kikuchi K. et al.Minimally Invasive coronary surgery compared to STernotomy coronary artery bypass grafting: the MIST trial.Contemp Clin Trials. 2019; 78: 140-145Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Because a sternotomy incision can lead to healing issues or chronic pain in nearly 30% of patients, with the average time period needed