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June 2023, Volume 73, Issue 6

Student's Corner

Minimally invasive Coronary artery bypass graft: Is this the future of traditional CABG?

Muhammad Rafay Shahzad Cheema  ( 4th Year MBBS Student, Allama Iqbal Medical College, Lahore, Pakistan. )

DOI: 10.47391/JPMA.8420


Madam, Minimally Invasive Coronary Artery Bypass Graft (MICS CABG) is a newly developed cardiac surgical technique that eschew median sternotomy and its correlated intricacies, while encouraging rehabilitation and conserving the advantages of surgical revascularization. For several decades, guidelines have stated coronary artery bypass grafting (CABG) as the benchmark revascularization procedure for multivessel and left main coronary artery disease (CAD)1. Nevertheless, CABG by sternotomy is an immensely intrusive measure correlated with various post-surgical adverse consequences. Furthermore, when given the option, majority of patients favoured percutaneous coronary intervention (PCI) over CABG to treat CAD, even with a high 1-year death risk and the possibility of repeat procedures in the case of PCI2. Thus, minimally encroaching techniques such as MICS CABG have been developed to re-envision surgical revascularization and direct attention to patient’s liking for a less aggressive procedure while sustaining the clinical result precedence of CABG over PCI.

Multiple studies have reported promising clinical outcomes of MICS CABG, rendering it a feasible and secure surgical technique that is affiliated with exceptional short-term results and quick graft patency3. A recent4 study by Zhang et al. reported angiographic data to assess graft patency in 186 patients who underwent MICS CABG utilizing the left internal thoracic artery (LITA) and saphenous vein (SV); they delineated encouraging results with 99.5% complete revascularization and total graft patency rate of 96.3% Furthermore, MICS CABG has gained precedence over CABG concerning the lower exchange of blood products, decreased frequency of chest scar infection, and enhanced postoperative physical recovery5.

These findings should be seen as a matter of keen interest in Pakistan where patients that report with CAD are usually in weak physical condition with multiple comorbidities such as high Blood Pressure (BP) and Type 2 Diabetes Mellitus (T2DM); which puts them at a greater risk of poor post-operative prognosis after conventional CABG despite the prompt requirement of the procedure. Such patients, along with those who avoid such invasive surgeries should be given this option as a safe alternative to CABG. Finally, it is of paramount significance that experts who desire to operate using this procedure to be equipped with authenticated, unbiased evaluation of the effectiveness and quality of this method. Whether MICS CABG in its present condition is apposite worldwide remains debatable, still the key finding is that multivessel coronary revascularization can be carried out with outstanding procedural and patency results. Upcoming studies should prioritize enhancing the generalizability and duplicability of this technique.


Submission completion date: 18-11-2022


Acceptance date: 26-01-2023


Disclaimer: None to declare.


Conflict of Interest: None to declare.


Funding Sources: None to declare.




1.      Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79: e21-e129.

2.      Kipp R, Lehman J, Israel J, Edwards N, Becker T, Raval AN. Patient preferences for coronary artery bypass graft surgery or percutaneous intervention in multivessel coronary artery disease. Catheter Cardiovasc Interv 2013; 82: 212-8.

3.      Davierwala PM, Verevkin A, Sgouropoulou S, Hasheminejad E, von Aspern K, et al. Minimally invasive coronary bypass surgery with bilateral internal thoracic arteries: Early outcomes and angiographic patency. J Thorac Cardiovasc Surg 2021; 162: 1109-19.e4.

4.      Zhang L, Fu Y, Gong Y, Zhao H, Wu S, Yang H, et al. Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery. J Card Surg 2021; 36: 992-7.

5.      Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg 2011; 40: 804-10.


2.      Hornberger J, Chhatwal J. Opioid Misuse: A Global Crisis. Value Health 2021; 24: 145-6.

3.      Osmundson SS, Min JY, Grijalva CG. Opioid prescribing after childbirth: overprescribing and chronic use. Curr Opin Obstet Gynecol 2019; 31: 83-9.

4.      Yaqub F. Pakistan's drug problem. Lancet 2013; 381: 2153-4.

5.      Majid Z, Tanveer M, Ali Asghar S, Tahir F, Minhaj A, Khan HA, et al. Opioids Use and Abuse: Prescription Practice, Attitude, and Beliefs among Doctors of Karachi. Cureus 2019; 11: e5253.

6.      Keller CE, Ashrafioun L, Neumann AM, Van Klein J, Fox CH, Blondell RD. Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain. Subst Abus 2012; 33: 103-13.

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