Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization

Abstract

Minimally invasive coronary revascularization techniques aim to avoid median sternotomy with its associated complications, while facilitating recovery and maintaining the benefits of surgical revascularization. The 3 most common procedures are minimally invasive coronary artery bypass grafting, totally endoscopic coronary artery bypass, and hybrid coronary revascularization. For a variety of reasons, including cost and technical difficulty, not many centers are routinely performing minimally invasive coronary revascularization. Nevertheless, many studies have assessed the safety and efficacy of each of these procedures in different clinical contexts. Thus far results have been promising, and with the evolution of procedural techniques, these approaches have the potential to redefine coronary revascularization in the future. This review highlights the current state of minimally invasive coronary revascularization techniques by exploring their benefits, identifying barriers to their adoption, and discussing future potential paradigms.

Transcatheter aortic valve replacement in patients undergoing robotic totally endoscopic coronary artery bypass: A case series

“…Our hospital is a referral center for robotic heart surgery and routinely offers single and multivessel totally endoscopic all arterial revascularization for appropriate candidates. As seen in Figure 1 , our approach for patients with CAD combined with AS demonstrates that TAVR can be safely completed prior to coronary revascularization ( 12 , 13 ). They returned to their pre-procedural activities within a few weeks of each procedure respectively and felt improvement of their previous symptoms.…”

Minimally Invasive Direct Coronary Artery Bypass Grafting: Sixteen Years of Single-Center Experience

“…Due to the demanding learning curve associated with the MIDCAB approach [ 32 , 33 ], it is important to note that maintaining a high quality of the MIDCAB procedure is achievable when it is carried out in high-volume centers, enabling surgeons to effectively sustain their skills [ 12 , 32 , 34 ].…”

Minimally invasive surgical coronary artery bypass in women

“…Case volume can affect outcomes following minimally invasive CABG ( 60 ). Despite its established safety and feasibility in appropriately selected patients, widespread implementation of minimally invasive CABG has yet to occur, and application of the procedure continues to be limited to a small number of experienced centers ( 30 , 31 ). Appropriate patient selection is critical to achieving acceptable outcomes and is aided with focused preoperative imaging (i.e., CT chest with angiography) and multidisciplinary collaboration.…”

“…Robotic mammary harvest, first described in 1999 by Mohr et al ( 28 ) and Loulmet et al ( 29 ), enables LIMA harvest via three robotic ports and facilitates a reduction in size of the anterior thoracotomy incision. Totally endoscopic coronary artery bypass (TECAB) surgery and multivessel revascularization using the bilateral internal mammary arteries are further advancements in technique, but remain limited to high-volume specialized centers ( 30 , 31 ).…”