Tactical and technical aspects of minimally invasive left internal mammary artery – left anterior descending artery bypass and hybrid coronary revascularization on its basis

Abstract

Reducing surgical trauma is one of the obvious ways of reducing perioperative risks and improving surgical techniques, which is also very positively perceived by patients. Hybrid coronary revascularization (HCR) is one of the ways of minimizing surgical trauma during coronary revascularization. Objectives: to note the tactical and technical aspects of the minimally invasive left internal mammary artery-left anterior descending artery bypass (mini-LIMA-LAD) and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones. Materials and methods: Between 2011 and 2019, 39 mini-LIMA-LAD operations were performed at the SI "V. T. Zaycev IGUS NAMSU". The average age of patients was 60.6±8.2 years, 5 (13 %) of patients were female. In nine patients mini-LIMA-LAD was the first (in eight) or second (in one) stage of the planned HCR. Results and discussion: There were no perioperative deaths, myocardial infarctions or conversions. At a median follow-up time of 49.5 [Q1; Q3: 34.3; 70.6] months one patient died 13 months after surgery. Four patients had angina recurrences at different times. The article discusses the tactical and technical aspects of mini-LIMA-LAD and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones. Conclusions: Mini-LIMA-LAD and HCR on its basis are a low-traumatic alternative to traditional coronary bypass through sternotomy with acceptable early and long-term results. They have a much better cosmetic effect, especially for women, but are more demanding in surgical technique and tissue handling. The strategy of coronary revascularization described, unlike other less traumatic techniques, does not require expensive additional equipment and can be performed by regular means