CONGRESS ABSTRACT

Introduction: Minimally invasive revascularization techniques for myocardial revascularization (MICS) of the left anterior descending coronary artery (LAD) with the left internal thoracic artery (LITA) include robot-assisted (RACAB) or direct left minithoracotomy (MIDCAB) approaches. These strategies, alone or combined with PCI in a hybrid setting, provide excellent survival outcomes while minimizing risk of complications especially in morbidly high-risk patients. We report early clinical outcomes of patients who underwent MICS. Methods: From December 2022 to October 2024, 105 patients underwent MICS for LIMA-to-LAD revascularization surgery (60 RACAB and 45 MIDCAB). Among these, stand-alone MICS was performed in 76 patients (72%) while others 29 (28%) had hybrid revascularization strategy by means of PCI of non-LAD diseased vessels based on heart-team decision. Female patients were 20% (21/105), mean age was 70±11, while median EuroScore II predictive risk for surgical mortality was 1.57% (range 0.50-11). Overall, 39 patients (37%) had a previous history of myocardial infarction and PCI. Results: Hospital mortality was 0.9% (1/105) while cumulative incidence of MACCEs (stroke/TIA, repeated revascularization, myocardial infarction, heart failure) was 2,8% (3/105) In particular, 2 bypass required early PCI to LAD for acute failure. In 3 patients, intraoperative prophylactic IABP was required for hemodynamic instability. Mean intubation time was 5,8±4 hours, mean length of stay was 12±6 days while 45 patients (43%) were discharged home without need for rehab. Discussion: MICS solutions, either as stand-alone or as a part of a hybrid strategy, provided excellent early clinical outcomes. Combining minimally invasive surgical strategies with percutaneous approaches allowed for complete revascularization even in those patients considered at high-risk for standard surgical approach. Moreover, multidisciplinary approach to high-risk patients, brings advantages of both percutaneous (PCI) and surgical revascularization techniques while minimizing risk of morbidity and mortality being the expected risk of mortality of 1.57% while the effective in-hospital mortality was 0.9%.