First experience of simultaneous minimally invasive coronary artery bypass grafting on the beating heart using «no touch aorta» technique and carotid endarterectomy in patients with unstable angina

The objective. To demonstrate early postoperative re-sults of simultaneous treatment of patients with unstable angina with stenosis of the left main coronary artery and carotid eversion endarterectomy (CEA). Material and methods. In the period from 2023 to 2024, 27 patients with stable forms of coronary heart disease (CHD) were operated. All patients underwent minimally invasive mul-tivessel coronary artery bypass grafting (MICS CABG) and CEA. MICS from left mini-thoracotomy using the left and right internal mammary arteries (BITA) and autovenous coronary artery bypass grafts using the «no touch aorta» technique. 12 patients underwent Y-shaped, composite sequential bypass surgery. All operations were performed without artificial circulation. 14 patients underwent CT-bypass angiography (CT-BA) on a 128-slice CT-scanner on the 7th day after surgery. Results. All patients under-went complete myocardial revascularization and CEA. 25 patients underwent complete autoarterial composite bimammary bypass surgery in LCA. 2 patients underwent sequential bypass surgery of the LCA and right coronary artery (RCA). All operations were performed without arti-ficial circulation. 14 patients underwent CT on a 128-slice CT-scanner on the 4th day after surgery. Conclusion. The indications and timing of simultaneous carotid endarter-ectomy with CABG are still controversial, and additional data collection is needed to decide on the best man-agement plan for this group of patients. Also, reducing the risk of developing a sternal infection requires further discussion of the need to use lateral minithoracotomy in routine practice. The BITA technique or the use of com-posite grafts should be used to achieve complete coro-nary revascularization; the «no touch aorta» technique is a promising technique of choice. Large randomized studies are still needed to confirm these results.