MICs-CABG – new technical developments and feasibility assessment by means of a complexity score.

Alexander Albert (Dortmund)1, K. Smiris (Dortmund)1, G. Petrov (Dortmund)1

1Klinikum Dortmund gGmbH Klinik für Thorax-, Herz- und Gefäßchirurgie Dortmund, Deutschland



MICs-CABG includes several variations of minimally invasive bypass surgery, where a sternotomy is avoided. While single bypass, with Lima on LAD, is an established procedure ( minimally invasive direct coronary artery bypass =MIDCAB), multiple bypass surgery via mini-thoracotomy is still not widely used. This is due to the fact that In addition to the required expertise in off-pump surgery, this is due to the technical difficulties in adequately accessing the postero-lateral wall of the beating heart through a mini-thoracotomy. We introduced techniqual innovations to overcome these issues and use a  score to estimate the complexity and technical feasibility. Methodology


Between 11.2019 and 08.2023, 350 minimally invasive bypass surgeries were performed. We introduce a score to estimate the complexity and technical feasibility for Multivessel-MIDAB, based on 4 criteria: A.  Cardio-thoaracic ration , 0.4-0.5 =1P, > 0.5 = 3P, B. EF 30-50% = 1P, EF < 30% = 3P, C. Lenght &Diameter of the vessels of the posterior wall: from 1P-5P, D. BMI 30-35 =1P, 35-40 =3P, >40= 6P. Over the 3 years, we have established 2 new techniques, which facilitate access to the lateral wall of the heart. We correlate the complexity score with the time Intervall, taking into account the introduction of the "lateral window" and the "bottom support"


Between 11.2019 and 08.2023 120 Multivessel MIDCAB. Over the entire period, the complexity score is 5.2. There is a significant correlation between the time interval and the increase in the complexity score (p<0.5). After the introduction of the lateral window, the mean score is 6, and after the introduction of the bottom support, it is 7.5. The average number of bypasses has risen from 2.0 to 2.3.  The share of hybrid processes is 25%


Multivessel-MIDCAB is becoming a standardized and reproducible procedure thanks to increasing experience and the introduction of specific methods for accessing the lateral wall of the heart.  A complexity score is suitable for estimating the possibilities for the individual patient. 

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