Single Coronary Artery Bypass Grafting Research Articles

Estimation of Radiation Doses and Lifetime Attributable Risk of Radiation-induced Cancer from A Single Coronary Artery Bypass Graft Computed Tomography Angiography

Introduction: Despite worldwide consensus that coronary artery bypass graft computed tomography angiography (CABG CTA) confers benefit to patients when used for appropriate indications, the increased cancer risk due to radiation dose remains a concern. The aim of this study is the estimation of organ effective dose (ED) and lifetime attributable risk (LAR) of cancer incidence and mortality related to a single CABG CTA procedure. Methods and materials: This retrospective cross-sectional designed study included 102 CABG patients who, from January 2021 to June 2021, underwent a retrospective 64-slice ECG-gated CABG CTA covering the area of the grafts with optimal image quality. The estimation of ED was done using the imPACT CT Dosimetry spreadsheet. LAR of cancer incidence was estimated for CABG CTA using the website X-rayrisk.com. Results: The mean total ED of CABG procedure was 15.35 mSv. The highest organ doses were those to the lungs (5.04 mSv) and breast (4.49 mSv). The cancer risk is higher in female (1 in 1516) than in male patients (1 in 1762). The LAR of cancer is higher for the younger age group in both males and females. The total whole-body ED demonstrated that CABG CTA is equivalent to 154 chest radiographs or 37 screening mammography studies, which in turn correspond to approximately 4.3 or 5-years of natural background radiation, respectively. Conclusions: Despite many benefits of CABG CTA, it is associated with a non-negligible risk of malignancy, so a careful risk/benefit assessment is recommended in justifying CABG CTA procedures, especially for young female patients.

Acute arterial embolism of lower extremity after mitral valve replacement in a chronic lymphocytic leukaemia patient: a case report

Introduction Acute arterial embolism is a potential severe complication after cardiac surgery: it can be a clinical manifestation of early prosthetic valve (PV) thrombosis, whose incidence is higher in case of mechanical mitral valve or in presence of subtherapeutic anticoagulation, hemodynamic (atrial fibrillation) or haemostatic (obesity, anaemia, renal failure) predisposing factors (1). EACTA guidelines recommend to start anticoagulation during the first 24 hours after surgery, balancing the haemorragic risk(2). Although, in presence of specific comorbidities and risk factors, life-threatening thrombotic events can complicate postoperative period even following the international recommendations. Methods We report a 73-year-old man, suffering from chronic lymphocytic leukaemia (without treatment) and paroxysmal AF who received mitral mechanical valve replacement with a On-X 27/29 mm valve placed on anti-anatomic position because of a severe mitral insufficiency (with chordal systolic anterior movement) and single coronary artery by-pass graft. Unfractionated heparin (UFH) and acetylsalicylic acid were started 18 hours after surgery, in order to maintain an aPTT ratio of 1.5 to 2.5. On postoperative day (POD) 4 patient presented sudden pain and signs of acute hypoperfusion in left leg (distal femoral artery territory), requiring urgent surgery. Transthoracic echocardiography was performed but limited by artefacts and suboptimal acoustic windows. Considering the high risk surgery and the usefulness of early transoesophageal echocardiography (TOE), the patient received a general anaesthesia with tracheal intubation. Results Successful open embolectomy on the common femoral artery was performed; UFH perfusion was maintained during the whole duration of the procedure without haemorrhagic complication. Intraoperative TEO detected spontaneous echo contrast in left atrial appendage and reduced motion with impaired coaptation of the right leaflet (red arrows in figure); neither valvular-atrial-ventricular thrombus nor increased transvalvular gradient nor regurgitation were found. Postoperative TEO (POD 3) showed a PV with normal leaflets movement, without significative stenosis/regurgitation. Warfarin was started on POD 4 and heparin bridging was discontinued when INR target range was reached. Discussion In patient with multiple thrombotic risk factor (id malignancy, AF) adequate anticoagulation level can be difficult to reach: in these cases, serious thrombotic complications must be highly suspected even when guidelines have been followed. Prompt diagnosis and aggressive treatment are crucial to guarantee a good prognosis. Early TOE and a “tailored” anticoagulation therapy play a fundamental role in the management of such complications.

Angina and left ventricular dysfunction: can we ‘reduce’ it?

Despite the evolution in pharmacology and devices, recurrent and persistent angina still represent a frequent issue in clinical practice. A 69-year-old Caucasian female patient has history of surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis with subsequent transcatheter valve-in-valve implantation for bioprosthesis degeneration and single coronary artery bypass graft with left internal mammary artery on left anterior descending (LAD). After transcatheter aortic valve implantation, she started to complain angina [Canadian Cardiovascular Society (CCS) Class III], effectively treated with bisoprolol uptitration and ivabradine 5 b.i.d. addition. After 6 months, she had a non-ST segment elevated myocardial infarction with evidence of left main occlusion and good functioning aortic bioprosthesis. A retrograde drug-eluting balloon percutaneous coronary intervention (PCI) on LAD (in-stent restenosis) was performed. However, the patient continued to complain angina (CCS Class II–III), even after further ivabradine increase to 7.5 mg b.i.d. After 4 months, the patient underwent Reducer implantation. After 2 months, angina started to improve and the patient is currently angina free. In the last decades, PCI materials and stents greatly improved. Medical therapy (such as β-blockers) has been shown not only to improve symptoms but also to add a prognostic benefit in patients with reduced ejection fraction (EF). Ivabradine showed additional benefits in patients with angina and reduced EF. However, still a relevant portion of patients complain refractory angina. The COSIRA trial showed that a coronary sinus Reducer was associated with greater angina relief than the sham procedure and could be a further step in angina treatment.

A Case of Exercise-Induced Chest Pain Due to Anomalous Right Coronary Artery

A 58-year-old male presented with 6-month history of exertional chest pain on a background of family history of family history of sudden death in brother at the age of 50. He underwent coronary angiogram and subsequent CTCA after positive exercise stress test. There was anomalous anterior origin of right coronary artery arising from left coronary cusp, coursing between the pulmonary artery and aorta without significant coronary stenosis. (Fig. 1). Heart team meeting consensus was that chest pain was due to exercise-induced pulmonary hypertension and patient was offered single coronary artery bypass grafting. Patient is doing well without recurrence of pain at 3 months of follow-up. The clinical outcome for ARCA is most often benign. Exercise induced cyclical compression and distorted slit-like ostium are thought to be mechanism of ischaemia. Patients who have symptoms of ischaemia or arrhythmia warrant more urgent surgical intervention, both for management of symptoms and reduction in risk of sudden cardiac death [[1]Ghosh P.K. Agarwal S.K. Kumar R. Chandra N. Puri V.K. Anomalous origin of right coronary artery from left aortic sinus.J Cardiovasc Surg (Torino). 1994; 35: 65-70PubMed Google Scholar]. This case illustrates the importance of considering ARCA as a differential diagnosis in patients presenting with exercise induced ischaemic chest pain, without any alternative explanations.

Outcome of Percoutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Surgery

in such patients. Patients and Methods: In this study, 111 symptomatic patients with pervious history of single coronary artery bypass graft (without concomitant vale surgery) underwent PCI by a single operator between March 2008 and March 2012. Then, they were followed during the following year after PCI and the incidence of death redo CABG, persistent cardiac symptom and rate of hospitalization were recorded Results: The successful rate of PCI in this study was estimated to be 94.5% (104 of 111). In hospital MACE was 9.6% (three deaths and one myocardial infarction). 67% (73) of patients were male and 33% (33) were female. 79.6% (86) of PCI procedures were done on native coronary arteries and 20.4% (22) on SVG grafts. During one year follow up, we had 7 death in patients with PCI on native vessels (group A) and 1 death in the patients whose PCI was performed on SVG grafts (group B), (P ≥ 0.999). In group A, 27.9% (24) patients were remained symptomatic; while in group B, 18.4% (4) patients were still symptomatic (P = 0.353). Hospitalization because of cardiac syndrome was recorded for 10.5% (9) patients in group A and 9.1% (2) patients of group B (P > 0.955). None of the patients of group B went under redo-CABG during the follow up but 2.3% (2) patients of group A did (P > 0.289). No case of stent restenosis or target vessel revascularization was recorded in either group. The overall rate of death was 7.6% (8 0f 104), persistent cardiac symptoms 27% (28 0f 104), hospitalization for cardiac symptoms 10.5% (11 f 14) and redo CABG 2% (2 of 104). Conclusions: This study shows that PCI in symptomatic post CABG patients follows by high successful and low complication rate and positive impression on their cardiac symptoms and could reduce the need for redo CABG. It seems that there is no difference that PCI is performing on SVG or native vessel, the intervention itself improves the patients’ quality of life.

IMMEDIATE CLINICAL OUTCOME OF ROBOTIC ASSISTED CABG IN PATIENTS WITH PREVIOUS HEART SURGERY

Redo Coronary artery bypass graft surgery on cardiopulmonary bypass is associated with significant morbidity and mortality in patients with previous heart surgery. In high risk patients like this, minimally invasive robotic-assisted surgical techniques can reduce adverse events, having a faster recovery and return to their normal activities. We evaluate the postoperative evolution of three patients with previous heart surgery that were treated with robotic-assisted coronary artery bypass grafting. We perform single coronary artery bypass graft surgery off pump in three male patients, between 2008 and 2013, using the DaVinci Si System. The three of them had previous aortocoronary bypass surgery without the utilization of Leith internal thoracic artery (LITA). Average age was 72.99 + 5.99 years old. The three procedures were urgent, and the patients were one in CCS Class 4a, other in CCS Class 4b and other in CCS Class 4c. All of them were diabetics, with no renal dysfunction. Surgery was performed using off pump technique, harvesting the LITA with the robot, and performing the anastomosis of IMA to LAD through a small left anterior minithoracotomy. No patient died or had any postoperative complication. The average ICU stay was of 1.3 + 0.58 days with a maximum ICU days of 2. The average hospital stay was of 3.3 + 0.58 days with a maximum hospital days of 4. The immediate postoperative results of robotic assisted single coronary artery bypass surgery in patients with previous heart surgery demonstrate great reproducible and efficacious results. This alternative approach enables possibility of reduce morbidity and mortality, with a faster recovery and return to their daily activities. Though our experience needs to evaluate more patients with this condition, the future results seem promising.

Endovascular Coil Embolization of Behçet Disease–Related Giant Aneurysm of the Right Coronary Artery After Failure of Surgical Suture

A 69-year-old man with Behcet disease (BD) was referred for treatment of a rapidly growing giant aneurysm (38 × 31 mm) of the right coronary artery (RCA), as detected by computed tomography ([Fig. 1][1]A). The patient initially underwent surgery for single coronary artery bypass grafting and RCA

Emergency Coronary Artery Bypass Grafting after Substernal Gastric Tube Interposition for Esophageal Cancer

A 67-year-old man who had undergone substernal gastric tube interposition due to esophageal cancer showed ST changes on electrocardiography. Diagnosis was severe stenosis of the left anterior descending branch that required emergency coronary artery bypass grafting. Preoperative computed tomography (CT) showed the feeding arteries of the gastric tube were in contact with the left internal mammary artery. Therefore, we felt harvesting this artery could be dangerous and decided to perform a median sternotomy, approaching from the right side of the gastric tube. The pericardium was easily and safely reached. We undertook on-pump cardiac arrest single coronary artery bypass grafting of the left anterior descending artery with a saphenous vein graft. The postoperative course was uneventful without mediastinitis. Cardiac surgery after esophageal cancer is often performed from a left thoracotomy. But, we recommend a median sternotomy be performed as an option. Preoperative contrast-enhanced CT should be considered as it may indicate the need for a significant revision such as a median sternotomy.

Anomalous Origin of Left Coronary Artery from the Pulmonary Trunk in a Mildly Symptomatic Adult Female

Anomalous origin of the left coronary artery from the pulmonary trunk, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly, and it often exists as an isolated condition. We hereby report an adult female who was admitted for mild chest discomfort and was accidentally diagnosed to have anomalous origin of the left coronary artery from the pulmonary trunk. This anomaly was simply repaired by using a bovine pericardial patch to obliterate the anomalous opening in the pulmonary trunk and a single coronary artery bypass graft. This report highlights the characteristic events of the anomaly in an adult with only mild symptoms.

Combined aortic valve replacement and coronary artery bypass grafting for a calcified ascending aorta

Although a severely calcified ascending aorta is encountered infrequently, it presents formidable problems during cardiac surgery. We describe a case of severe aortic valve stenosis and coronary artery disease combined with a severely calcified ascending aorta. The patient was an 80-year-old man with a calcified ascending aorta. He successfully underwent an aortic valve replacement and a single coronary artery bypass graft (CABG) using a saphenous vein graft with the proximal end connected on a Dacron patch, which was used for aortoplasty of the calcified plate along the aortotomy. These procedures were performed under moderate hypothermia with aortic clamping. This patch aortoplasty can be a useful alternative in cases that require aortotomy and proximal anastomoses of a CABG on a calcified ascending aorta.

Comparison between intravenous and thoracic epidural analgesia in single coronary artery bypass graft surgery

Aim: To compare thoracic epidural analgesia with intravenous analgesia in patients who underwent coronary artery bypass grafting surgery. Materials and methods: This retrospective study included 40 patients who had received elective single artery bypass surgery. After general anesthesia, one group was given patient-controlled thoracic epidural analgesia and the other group was given patient-controlled intravenous meperidine analgesia. Patient assessments were performed during the postoperative period and included the duration of hospital stay, pain and sedation scores, ambulation score, atrial fibrillation incidence, and organ morbidities. Results: No differences were detected between the groups in the demographic or intraoperative data. However, a statistically significant difference was detected in favor of thoracic epidural analgesia for the duration of extubation and hospital stay, pain control, sedation grade, mobilization, and quality of recovery scores. Conclusion: After single coronary artery surgery, thoracic epidural analgesia was more effective than intravenous analgesia; it also enabled earlier tracheal extubation and a shorter hospitalization period.

Tailored Medical and Interventional Therapy Against Recurrent Stent Thrombosis After Drug-Eluting Stenting

Dual antiplatelet therapy with aspirin and a thienopyridine (ticlopidine or clopidogrel) has strikingly improved the results of percutaneous coronary intervention (PCI) through a marked reduction in the rate of stent thrombosis (ST). Emerging data suggest that resistance to antiplatelet treatment may be a risk factor for ST. We report about a patient, aspirin and clopidogrel poor responder, who experienced 4 ST in 10 days. After the second ST, during antiplatelet therapy with aspirin (100 mg/die) and clopidogrel (75 mg/die), the patient's platelet function was investigated with Platelet Function Analyzer 100, VerifyNow P2Y12 System and light transmission aggregometry (LTA). High platelet reactivity and combined resistance to aspirin and clopidogrel were found, and, as a consequence, treatment was switched to clopidogrel 150 mg and aspirin 300 mg/die. In spite of this adjustment, the third ST occurred. Poor responsiveness to aspirin and clopidogrel was still confirmed. Because of combined clopidogrel and aspirin resistance and to unsuccessful PCI treatment, a single coronary artery bypass graft (CABG) was planned. Awaiting surgery, 3 days later, the fourth ST occurred. It is angiographically confirmed and thus, CABG was performed. After CABG, in chronic treatment with aspirin (300 mg/die) and ticlopidine (500 mg/die), no bleeding complications occurred and the patient did not experience recurrent ischemia (2 years follow-up). A better platelet inhibition by ticlopidine than that obtained by clopidogrel was observed. Our case report remarks the importance to identify these poor responder patients as the treatment can be tailored with alternative therapeutic options (ticlopidine, prasugrel, warfarin) and/or different revascularization strategies (CABG).

Sinus of Valsalva Aneurysm Masquerading as Coronary Artery Disease

A 53-year-old man had recurrent angina after single coronary artery bypass grafting (left internal thoracic artery [LITA] to the left anterior descending coronary artery [LAD]). Subsequent investigations showed an aortic root mass (A) (see computed tomographic scan, Figs 1A and 1B) behind the main pulmonary artery (MPA), arising from the aortic sinus (see Fig 2; transesophageal echocardiographic, long-axis view at mid-esophageal, aortic valve level; LA = left atrium; Asc Ao = ascending aorta; LV/RV = left/right ventricle; LVOT = left ventricle outflow tract). The LITA graft was patent, but the distal run-off was small, serving a hypokinetic region.Fig 2View Large Image Figure ViewerDownload (PPT)Intraoperatively a large true Sinus of Valsalva aneurysm was identified just below the left coronary orifice (Fig 3; LCA = left coronary artery). An uneventful pericardial patch closure of the aneurysm neck was performed. As the native LAD was small and the anterior left ventricular motion was poor, the vessel was not re-grafted.Fig 3View Large Image Figure ViewerDownload (PPT)An aortogram was not performed in his pre-CABG angiography, but an unusually large gap between the LAD and circumflex arteries (Cx) was already evident (Fig 4; OM = obtuse marginal; D1 = first diagonal branch). In retrospect, the smooth but long segment stenosis on the proximal LAD and the abnormal distance from circumflex suggested the presence of a space-occupying lesion. Sinus of Valsalva aneurysm is rare and only 1% arise from the left [1Guo D.W. Cheng T.O. Lin M.L. Gu Z.Q. Aneurysm of the sinus of Valsalva: a roentgenologic study of 105 Chinese patients.Am Heart J. 1987; 114: 1169-1177Abstract Full Text PDF PubMed Scopus (52) Google Scholar]. Coronary insufficiency as a result of external compression is uncommon but should be considered in angina with unusual angiographic appearances [2Lijoi A. Parodi E. Passerone G.C. Scarano F. Caruso D. Iannetti M.V. Unruptured aneurysm of the left sinus of Valsalva causing coronary insufficiency: case report and review of the literature.Tex Heart Inst J. 2002; 29: 40-44PubMed Google Scholar].Fig 4View Large Image Figure ViewerDownload (PPT) A 53-year-old man had recurrent angina after single coronary artery bypass grafting (left internal thoracic artery [LITA] to the left anterior descending coronary artery [LAD]). Subsequent investigations showed an aortic root mass (A) (see computed tomographic scan, Figs 1A and 1B) behind the main pulmonary artery (MPA), arising from the aortic sinus (see Fig 2; transesophageal echocardiographic, long-axis view at mid-esophageal, aortic valve level; LA = left atrium; Asc Ao = ascending aorta; LV/RV = left/right ventricle; LVOT = left ventricle outflow tract). The LITA graft was patent, but the distal run-off was small, serving a hypokinetic region. Intraoperatively a large true Sinus of Valsalva aneurysm was identified just below the left coronary orifice (Fig 3; LCA = left coronary artery). An uneventful pericardial patch closure of the aneurysm neck was performed. As the native LAD was small and the anterior left ventricular motion was poor, the vessel was not re-grafted. An aortogram was not performed in his pre-CABG angiography, but an unusually large gap between the LAD and circumflex arteries (Cx) was already evident (Fig 4; OM = obtuse marginal; D1 = first diagonal branch). In retrospect, the smooth but long segment stenosis on the proximal LAD and the abnormal distance from circumflex suggested the presence of a space-occupying lesion. Sinus of Valsalva aneurysm is rare and only 1% arise from the left [1Guo D.W. Cheng T.O. Lin M.L. Gu Z.Q. Aneurysm of the sinus of Valsalva: a roentgenologic study of 105 Chinese patients.Am Heart J. 1987; 114: 1169-1177Abstract Full Text PDF PubMed Scopus (52) Google Scholar]. Coronary insufficiency as a result of external compression is uncommon but should be considered in angina with unusual angiographic appearances [2Lijoi A. Parodi E. Passerone G.C. Scarano F. Caruso D. Iannetti M.V. Unruptured aneurysm of the left sinus of Valsalva causing coronary insufficiency: case report and review of the literature.Tex Heart Inst J. 2002; 29: 40-44PubMed Google Scholar].

Massive Bilateral Pulmonary Emboli Complicating Coronary Artery Bypass Grafting: A Case Report

We report an unusual case of massive bilateral pulmonary emboli following single coronary artery bypass grafting on cardiopulmonary bypass. The patient was admitted electively, received deep vein thrombosis prophylaxis, and had no clinical evidence of deep vein thrombosis in the perioperative period. On the tenth postoperative day he developed sudden dyspnea and a diagnosis of pulmonary embolus was made with computed tomography. Despite full anticoagulation he continued to deteriorate, and despite attempts at pulmonary embolectomy he died of right-sided heart failure. Post-mortem confirmed the diagnosis, but there was no evidence of thrombi in the pelvic and leg veins.

Reversed-J Inferior Versus Full Median Sternotomy: Which Is Better for Awake Coronary Bypass Surgery

The aim of this study was to ascertain whether the approach with a less invasive reversed-J inferior sternotomy could improve intraoperative patient compliance and postoperative recovery than the standard median sternotomy. Seventeen patients underwent elective single coronary artery bypass graft operation under high thoracic epidural anesthesia without endotracheal intubation. The reversed-J sternotomy was performed in 10 patients (Group A) and full sternotomy in 7 patients (Group B). The technical and surgical difficulties, pulmonary functions (by spirometric tests) and hospital stay were assessed. Through the reversed-J sternotomy coronary revascularization was accomplished without any additional technical difficulties and with a good exposure of both the left anterior descending artery and the left internal thoracic artery. No conversion to standard sternotomy and no intubation were observed. Additional doses of local anesthetic at jugular notch was not required in Group A. Pleura was opened more in Group B (57% vs. 20%; p = 0.14). Oxygen saturation was better in Group A during the surgical procedure (98.8 +/- 0.7% vs. 97.1 +/- 2.1%; p = 0.033), however, intraoperative PaCO2 was similar in both the groups. The patients in Group A were discharged from the hospital earlier (3.2 +/- 1.5 vs. 7.3 +/- 3.5 days; p = 0.004). Less invasive approach to coronary artery bypass graft operations is possible through combination of the high thoracic epidural anesthesia and a reversed-J sternotomy. This technique is less traumatic for patient and provides practical better oxygenation and shorter hospital stay.

Robotic Cardiac Surgery at Epworth Hospital

Epworth Hospital is the first in the southern hemisphere to acquire the da Vinci Robot to facilitate minimally invasive cardiac surgery. Applications for this new technology include mitral valve repair, atrial septal defect closure, single coronary artery bypass graft to coronary arteries on the front of the heart, ablative surgery for atrial fibrillation and insertion of epicardial pacemaker electrodes. A team of surgeons from the Epworth Hospital have trained at East Carolina University (ECU) Greenville, North Carolina, USA; including surgeons, anesthetists, perfusionist and nurses. Following this, during a week in March, a proctoring surgeon from the USA, Dr. Wiley Nifong, assisted the Epworth team with their initial seven operations, which all proceeded without incident. The initial operative times were longer than the standard surgery, although with additional experience, now totalling 24 patients in all, these times have shortened considerably. The experience to date is summarized as an Addendum to this manuscript.

Reoperative coronary artery bypass grafting using a minimally invasive direct coronary artery bypass procedure.

Reoperative coronary artery bypass grafting with cardiopulmonary bypass tends to cause a higher mortality and morbidity than the primary operation. The purpose of this study was to discuss the effectiveness and safety of a minimally invasive coronary artery bypass procedure for patients who had previously undergone coronary artery bypass surgery. We performed redo single coronary artery bypass grafting to the left anterior descending coronary artery in 9 patients and to the right coronary artery in 3 patients using minimally invasive cardiac surgery. The graft to the left anterior descending coronary artery was taken from the left internal thoracic artery in 5 patients, the right gastroepiploic artery in 3 patients, and from the saphenous vein in the other 1 patient. The graft to the right coronary artery was from the right gastroepiploic artery in all 3 patients. All grafts were patent. There was no major postoperative complication and no surgical or hospital death except one late death. In selected patients, we could safely and completely perform coronary artery bypass re-grafting to the left descending coronary artery or right coronary artery using a minimally invasive operation.

Postoperative atrial fibrillation: An old problem crying for new solutions

J Thorac Cardiovasc Surg 2001;121:638-41

Single coronary artery bypass grafting--a comparison between minimally invasive 'off pump' techniques and conventional procedures.

At present, few studies directly comparing minimally invasive and conventional coronary artery bypass grafting are available. The aim of the present study was to evaluate the clinical outcome of the two techniques. We retrospectively compared our first consecutive 20 patients undergoing minimally invasive coronary artery single bypass grafting on the beating heart (group I) with 23 consecutive patients receiving single coronary artery bypass via sternotomy using cardiopulmonary bypass and cardioplegia (group II). The procedures were performed during the period from Jan 1, 1994 to Feb 20, 1997. There were no significant differences in demographic data. Statistically significant differences were found concerning total operative time (172.6 min in group I and 149.6 min in group II P = 0.0009) and myocardial ischemic time (23.7 min local coronary occlusion time in group I and 17.6 min aortic cross-clamp time in group II P = 0.03. Patients treated minimally invasive received significantly fewer blood transfusions (25.0% vs. 69.6% P = 0.0035) and were discharged significantly earlier from the hospital (admission rate on the fifth postoperative day 68.4% in group I vs. 100.0% in group II P = 0.0004). We conclude that minimally invasive coronary artery bypass grafting on the beating heart in comparison to conventional single coronary artery bypass grafting during the learning curve requires longer operative times but can reduce blood transfusion requirements and hospital stay.