Minimally Invasive Coronary Artery Bypass Grafting for Predominantly Multivessel Coronary Artery Disease: Early Perioperative Outcomes of 149 Patients.

Background Minimally invasive coronary artery bypass grafting (MICS-CABG) has evolved from single-vessel revascularization to multivessel surgery without median sternotomy. Although favorable outcomes have been reported, experience remains concentrated in specialized centers. This study evaluated the demographic, operative, and early postoperative characteristics of patients undergoing MICS-CABG, off-pump coronary artery bypass grafting (OP-CABG) at a single institution. Methods This retrospective observational study included 149 CABG/OPCAB procedures identified from an institutional database of 186 cardiac surgical records. Demographics, cardiovascular risk factors, operative details, number of grafts, cardiopulmonary bypass (CPB) and cross-clamp times, postoperative ventilation, chest drainage, transfusion requirements, and documented complications were analyzed. Continuous variables were summarized as mean ± standard deviation and median with interquartile range (IQR), and categorical variables as frequencies and percentages. Missing data were not imputed. Results The mean age was 57.8 ± 9.5 years; 139 (93.3%) patients were men. Diabetes mellitus was present in 86 patients (57.7%), hypertension in 100 (67.1%), and tobacco exposure in 65 (43.6%). Procedures included eight one-graft, 41 two-graft, 86 three-graft, and 13 four-graft operations; one procedure lacked standardized graft documentation. Overall, 140/149 (94.0%) procedures had two or more explicitly coded grafts. CPB data were available for 137 patients, with a mean duration of 170.2 ± 37.4 minutes and a median of 168 minutes (IQR: 148-190). Mean cross-clamp time was 94.6 ± 30.5 minutes. Ventilation data were available for 146 patients, with a mean duration of 7.6 ± 4.4 hours and a median of six hours (IQR: 4-11). Chest drainage was documented in 134 patients, with a mean of 899 ± 510 mL. Early postoperative outcomes included conversion to sternotomy in nine patients (6.0%), return to the operating room for bleeding in nine (6.0%), stroke in 3 (2.0%), respiratory insufficiency in two (1.3%), new-onset atrial fibrillation in 36 (24.2%), and 30-day or in-hospital mortality in three (2.0%). Outcome-specific denominators were based on the number of patients for whom the corresponding variable was available. Conclusion This institutional experience demonstrates the feasibility of minimally invasive coronary surgery for predominantly multivessel revascularization. Most procedures involved two or more grafts, with three-graft surgery being the most common. Postoperative ventilation was generally short; however, incomplete complication and transfusion documentation limits interpretation of other perioperative outcomes. Prospective standardized data collection and comparative studies with conventional CABG are warranted.