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Review paper

Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience

By
Nermir Granov Orcid logo ,
Nermir Granov

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Armin Šljivo ,
Armin Šljivo
Contact Armin Šljivo

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Ermina Mujičić ,
Ermina Mujičić

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Damir Rebić ,
Damir Rebić

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Alen Džubur ,
Alen Džubur

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Edin Begić ,
Edin Begić

Department of Cardiology, General Hospital “Prim. Dr Abdulah Nakaš“, Sarajevo, Bosnia and Herzegovina

Tarik Selimović ,
Tarik Selimović

Clinical Centre , University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Zlatan Zvizdić ,
Zlatan Zvizdić

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Almir Fajkić ,
Almir Fajkić

School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Asmir Jonuzi ,
Asmir Jonuzi

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Edin Kabil ,
Edin Kabil

Clinical Centre , University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Slavenka Štraus
Slavenka Štraus

Clinical Centre, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Abstract

Aim
This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery
(MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG).
Methods
This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients
with indication for surgical revascularization.
Results
Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28).
Conclusion
Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.

References

1.
Previtali E, Bucciarelli P, Passamonti SM, Martinelli I. Risk factors for venous and arterial thrombosis. Blood Transfus. 2011;9:120–38.
2.
Severino P, D’Amato A, Pucci M, Infusino F, Birtolo LI, Mariani MV, et al. Ischemic heart disease and heart failure: Role of coronary ion channels. Int J Mol Sci. 2020;21(3167).
3.
Obradovic S, Begic E, Jankovic S, Romanovic R, Djenic N, Dzudovic B, et al. Association of PC and AT levels in the early phase of STEMI treated with pPCI with LV systolic function and 6-month MACE. Acta Clin Belg. 2020;1–7.
4.
Gu D, Qu J, Zhang H, Zheng Z. Revascularization for coronary artery disease: Principle and challenges. Adv Exp Med Biol. 2020;
5.
Doenst T, Haverich A, Serruys P, Bonow RO, Kappetein P, Falk V, et al. PCI and CABG for Treating stable coronary artery disease: JACC review topic of the week. J Am Coll Cardiol. 2019;73:964–76.
6.
Smilowitz NR, Alviar CL, Katz SD, Hochman JS. Coronary artery bypass grafting versus percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock. Am Heart J. 2020;226:255–63.
7.
A FH, J K, A M, C A, WD K. Review of contemporary techniques for minimally invasive coronary revascularization. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2021;16:231–43.
8.
Ishikawa N, Watanabe G. Robot-assisted Cardiac Surgery. Ann Thorac Cardiovasc Surg. 2015;21:322–8.
9.
Rodriguez M, Ruel M. Minimally invasive multivessel coronary surgery and hybrid coronary revascularization: can we routinely achieve less invasive coronary surgery? Methodist Debakey Cardiovasc J. 2016;12:14–9.
10.
Kirmani BH, Mazhar K, Fabri BM, Pullan DM. Comparison of the EuroSCORE II and Society of Thoracic Surgeons 2008 risk tools. Eur J Cardiothorac Surg. 2013;44:999–1005.
11.
Shahian DM, Jacobs JP, Badhwar V, Kurlansky PA, Furnary AP, Cleveland JC, et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: Part 1—background, design considerations, and Model Development. Ann Thorac Surg. 2018;105:1411–8.
12.
Tully A, Bishop MA. Coronary artery surgery. In: StatPearls [Internet] Treasure Island. 2023.
13.
Teman NR, Hawkins RB, Charles EJ, Mehaffey JH, Speir AM, Quader MA, et al. Minimally invasive vs open coronary surgery: a multi-institutional analysis of cost and outcomes. Ann Thorac Surg. 2021;111:1478–84.
14.
Rabindranauth P, Burns JG, Vessey TT, Mathiason MA, Kallies KJ, Paramesh V. Minimally invasive coronary artery bypass grafting is associated with improved clinical outcomes. Innovations (Phila. 2014;9:421–6.
15.
Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg. 2011;40:804–10.
16.
George A, Baishya J, Krishnamoorthy J, Muniraju G, Chakravarthy M. Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome. Ann Card Anaesth. 2017;20(57).
17.
Rajput NK, Kalangi TKV, Andappan A, Swain AK. MICS CABG: a single-center experience of the first 100 cases. Indian J Thorac Cardiovasc Surg. 2021;37:16–26.
18.
Liang L, Ma X, Kong Q, Xiao W, Liu J, Chi L, et al. Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: a singlecenter retrospective cohort study. Cardiovasc Diagn Ther. 2022;12:378–88.
19.
Birla R, Patel P, Aresu G, Asimakopoulos G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann R Coll Surg Engl. 2013;95:481–5.
20.
Lichtenberg A, Hagl C, Harringer W, Klima U, Haverich A. Effects of minimal invasive coronary artery bypass on pulmonary function and postoperative pain. Ann Thorac Surg. 2000;70:461–5.
21.
Ruel M, Une D, Bonatti J, McGinn JT. Minimally invasive coronary artery bypass grafting: is it time for the robot? Curr Opin Cardiol. 2013;28:639–45.

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