BACKGROUND: The aorta no-touch total arterial minimally invasive coronary artery bypass grafting (MICS CABG) operation performed via a small thoracotomy (Figure 1) has not previously been examined in a direct comparison to MICS CABG with aortic manipulation. 

METHODS: We matched, according to age, gender, left ventricular function, and number of disease vessels, 100 patients who underwent aorta no-touch MICS CABG via small left thoracotomy, and100 patients who received MICS CABG with aortic manipulation (Figure2）. Table 1 shows preoperative patient’s Characteristics.

RESULTS: Table 2 shows the intraoperative outcomes. The average distal anastomosis was 2.8 in no-touch group and 3.3 in manipulation group (p<0.01). The use of bilateral internal thoracic artery was 81 (81%) in no-touch group and 41 (41%) in manipulation group (p<0.01). Total arterial revascularization underwent in 100% of no-touch group and in none of manipulation group. Table 3 shows the postoperative outcomes. There was no perioperative mortality (0/200). There are 1 (1%) stroke in no-touch group, that was developed in late postoperative days, and 0 (0%) in manipulation group. In the manipulation group, conversion to on-pump occurred in 2/100 (2.0%) patients. There were two (2.0%) reoperations for bleeding in aorta no-touch group. One (1.0%) anastomotic revision in aorta no-touch group was less than seven (7.0%) in manipulation group significantly (p=0.03). The median length of ICU stay was 2 days for aorta no-touch group (average 2.6), and 3 days for manipulation group (average 3.3) (P= 0.04). New-onset atrial fibrillation occurred in 8 (8.0%) both groups. Wound infection occurred 4 (4.0%) with both groups. A self-limiting left pleural effusion developed in 34 (34%) no-touch group and in 42 (42%) manipulation group. The median time to return to full physical activity was 11 days in no-touch group versus 13 days in manipulation group.

CONCLUSIONS: Aorta no-touch total arterial MICS CABG is a valuable alternative for patients in need of multivessel CABG. The operation appears at least as safe as MICS CABG with aorta manipulation, and associated with shorter length of ICU stay, less anastomotic revision, and faster postoperative recovery than MICS CABG with aortic manipulation.