Minimally Invasive Multivessel Coronary Artery Bypass Grafting Using Total Coronary Revascularization Via Left Anterior Minithoracotomy in Octogenarians

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Background: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated favorable early and midterm results in unselected patients with coronary artery multivessel disease. However, safety and outcomes in elderly patients remain less well defined. Particularly in octogenarians with relevant comorbidities, data are scarce, and the role of TCRAT compared to conventional coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate in-hospital and midterm outcomes of TCRAT in patients aged ≥ 80 years. Method: From 11/2019 to 10/2025, CABG via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic arrest was performed as a routine procedure in 859 consecutive, nonemergency patients. Among them, 82 patients (9.5%) were octogenarians, all presenting with multivessel coronary artery disease. In this subgroup, mean BMI was 26.5 ± 3.1 kg/m², left ventricular ejection fraction was 49.2 ± 9.1% (range 20–55 %), and mean EuroSCORE II was 5.1 ± 2.4. Comorbidities included diabetes mellitus (24.4 %), chronic lung disease (7.3 %), prior PCI (23.2 %), and peripheral vascular disease (78.5 %). The mean follow-up (100 %) was 9.1 months. Results: Left internal thoracic artery was used in 98.8 %, radial artery was used in 43.9 %. A mean of 3.0 ± 0.9 (range 2-5) anastomoses per patient was performed. Total operation time was 299 ± 64 min (range 164 - 480). In-hospital mortality was 1.2 %, stroke rate was 1.2 %, myocardial infarction rate was 0 % and repeat revascularization rate was 1.2 %. At follow-up, all-cause mortality, myocardial infarction, repeat revascularization, and stroke was 4.9 %, 0 %, 2.4 %, and 1.2 %, respectively. Overall major adverse cardiac and cerebrovascular events rate (MACCE) was 7.3 % at follow up. Conclusion: TCRAT enables complete coronary artery revascularization in multivessel coronary artery disease without sternotomy and can be safely performed in octogenarians. Both in-hospital and midterm outcomes were favorable and comparable to contemporary outcomes of conventional CABG in elderly patients.

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