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Ashenhurst et al. Vessel Plus 2024;8:3 Vessel Plus
DOI: 10.20517/2574-1209.2023.90

Review Open Access

Early and long-term outcomes of less invasive

approaches to coronary artery bypass surgery

1
1
1
Christine Ashenhurst 1,2,# , Omar Toubar 1,3,# , Ming Hao Guo , Hugo Issa , Menaka Ponnambalam , Marc Ruel 1
1
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
2
Department of Chemistry, Faculty of Science, University of Victoria, Victoria, BC V8W 2Y2, Canada.
3
Faculty of Medicine, McGill University, Montréal, QC H3A 0G4, Canada.
#
Authors contributed equally.
Correspondence to: Dr. Marc Ruel, Division of Cardiac Surgery, University of Ottawa Heart Institute, 3402-40 Ruskin Street,
Ottawa, ON K1Y 4W7, Canada. E-mail: mruel@ottawaheart.ca
How to cite this article: Ashenhurst C, Toubar O, Guo MH, Issa H, Ponnambalam M, Ruel M. Early and long-term outcomes of
less invasive approaches to coronary artery bypass surgery. Vessel Plus 2024;8:3. https://dx.doi.org/10.20517/2574-1209.2023.
90

Received: 26 Jul 2023 First Decision: 20 Nov 2023 Revised: 25 Dec 2023 Accepted: 3 Jan 2024 Published: 15 Jan 2024

Academic Editor: Giuseppe Andò Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
This review outlines the development of less invasive treatments for coronary artery disease, focusing primarily on
minimally invasive coronary artery bypass grafting (MICS CABG). We compare conventional coronary artery
bypass grafting (CABG) and MICS CABG indications and contraindications, surgical techniques, early and long-
term outcomes, and the process of implementation of MICS CABG to cardiac surgery programs. The invasiveness
of cardiopulmonary bypass and the sternotomy incision used in conventional CABG are appreciably mitigated by
the MICS CABG procedure, which is generally performed off-pump and through a left mini-thoracotomy. In the
literature, MICS CABG is a feasible alternative to sternotomy CABG with safe, reproducible, efficient, and durable
outcomes.

Keywords: Coronary artery disease, coronary artery bypass grafting, minimally invasive, minimally invasive
coronary artery bypass grafting, mini-thoracotomy, learning curve

INTRODUCTION
Cardiovascular diseases are the predominant cause of death worldwide, accounting for 32% of deaths

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