Abstract
BACKGROUND: To explore the feasibility and safety of performing a complete thoracoscopic ultrasonic scalpel procedure to harvest the left internal mammary artery (LIMA) during minimally invasive coronary artery bypass grafting (CABG) in high-risk patients. METHODS: This retrospective study compiled data from patients who underwent minimally invasive CABG with LIMA harvesting via thoracoscopic ultrasonic scalpel at the Department of Cardiothoracic Surgery, D'E Hospital, from January 2022 to July 2023. RESULTS: The study comprised eight patients with STS scores ≥ 7, among whom three were over 80 years old and five had low left ventricular ejection fractions (LVEF). The median operation duration was 220 min (range: 175-270), and all patients underwent single-vessel grafting. For patients with multiple lesions in addition to left anterior descending (LAD) lesions, 5 patients underwent hybrid procedures; for non-LAD lesions, elective Percutaneous Coronary Intervention (PCI) was performed. The LIMA pulsatility index exceeded 1.0 in all cases. Median blood loss was 26 ml (range: 7-300). The median durations of endotracheal intubation and chest drainage were 69 h (range: 12-144) and 25 h (range: 16-36), respectively. Immediate postoperative LVEF averaged 34% (range: 20%-70%). ICU stay and hospitalization lasted for a median of 132.5 h (range: 71-212) and 7 days (range: 6-16), respectively. Complications included atrial fibrillation in one patient, as well as pneumonia and new-onset heart failure in another. CONCLUSIONS: The study suggests that the complete thoracoscopic ultrasonic scalpel-assisted LIMA harvesting in high-risk surgical patients undergoing minimally invasive single-vessel CABG surgery has the potential to be a feasible and safe approach. Further research and larger studies are warranted to confirm these preliminary results.