Minimally invasive off‐pump anaortic coronary artery bypass (MACAB)

Abstract

Background Minimally invasive direct coronary artery bypass has enabled coronary artery bypass graft to compete with the appeal of less invasive percutaneous coronary procedures. Favorable results of coronary artery bypass surgery performed without the use of cardiopulmonary bypass and without touching the aorta (anOPCAB) have enabled the development and use of minimally invasive methods. Methods Between 2016 and 2021, 112 patients underwent multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off‐pump, anaortic, and all‐arterial grafts (Minimally Invasive Off‐Pump Anaortic Coronary Artery Bypass [MACAB]). Patient data were collected and retrospectively analyzed. Eight series from the literature using the multivessel mini‐OPCAB and MACAB technique were also evaluated. Results Collectively, from the literature, 2729 patients underwent an average of 2.4 bypasses with an early mortality rate of 0.7% and a stroke rate of 0.16%. In our MACAB case series, 112 patients underwent an average of 2.9 bypasses with a mortality rate of 1.8% and a stroke rate of 0%. Conclusion MACAB can be performed safely by experienced surgeons and reduces neurological injury and surgical trauma and may be a good alternative for multivessel stenting. Simulation systems are essential for its dissemination, and teams dedicated to coronary surgery—with subspecialty expertise—are necessary to achieve good outcomes.

Reply to: Anaortic With No Touch to the Aorta Is a Central Technique to Decrease Invasiveness of CABG

“…We believe that a sternal-sparing, off-pump, aortic-no-touch approach with bilateral internal thoracic artery grafts (as described by the minimally invasive off-pump anaortic coronary artery bypass procedure) 5 realizes all of the goals of a minimally invasive operation. However, we are also convinced that robotic techniques can enhance such a procedure in 2 ways.…”

The Feasibility and Early Results of Multivessel Minimally Invasive Coronary Artery Bypass Grafting for All Comers

“…Individuals who have a heavily calcified ascending aorta and moderate to severe chronic obstructive pulmonary disease, severe peripheral artery disease, borderline renal disorder, and severe deformities were preoperatively assigned to the off-pump anaortic technique according to the results of the preoperative evaluation. The MACAB (off-pump, anaortic) technique has been described in detail in previously published articles [14,15]. The method described here is the minimally invasive coronary artery bypass with an on-pump and clamped technique.…”

“…We present the MICAB method to all consecutive patients who apply for surgical treatment of isolated coronary artery disease without considering any contraindication. MICAB is performed routinely with the modified on-pump clamped multivessel MIDCAB technique for all consecutive patients requiring isolated coronary artery bypass grafting or the minimally invasive off-pump anaortic coronary artery bypass (MACAB) technique [14,15] for those with porcelain aorta, peripheral artery disease, and chest deformities, etc.…”

Minimally Invasive Off-Pump Anaortic Complete Arterial Coronary Artery Bypass: How to Do It?

“…2 The combination of anOPCAB with minithoracotomy might eliminate the stroke risk and provide a complete arterial revascularization sparing median sternotomy and can be called minimally invasive off-pump anaortic coronary artery bypass (MACAB). 3 The MACAB technique is described step by step.…”