In order to reduce the invasiveness of conventional coronary artery bypass grafting with complete median sternotomy and the associated limitations in terms of physical activity, postoperative quality of life and pain, various minimally invasive procedures and techniques, such as robot-associated bypass procedures or MICS-CABG, have been developed. Due to the technical complexity and the enormous infrastructural requirements, these minimally invasive techniques have not yet been used in routine care, but are currently only used in specialized centers and on highly selected patients. A surgical technique that systematically eliminates sternotomy while allowing the key principles of complete revascularization and broad applicability to the vast majority of patients has not been available to date.

In 2019, the Ukrainian cardiac surgeon Prof. O. Babliak and colleagues presented a new surgical approach for total coronary revascularization in multivessel coronary disease via a left anterior mini-thoracotomy (TCRAT), which completely eliminates the need for a sternotomy. This technique was implemented in the Heart-Thorax Center at Klinikum Fulda gAG as one of the first clinics in the world in 2019 and is meanwhile used as a routine procedure. It can be used in unselected patients using proven surgical techniques such as the use of cardiopulmonary bypass, cardioplegic cardiac arrest and standard techniques of coronary anastomoses. By avoiding a sternotomy, patients can be mobilized quickly and immediately put full strain on their thorax, which greatly improves convalescence and comfort for patients compared to standard coronary bypass grafting. The results that have already been published are promising. The lecture will describe the surgical technique in detail and then present in-hospital and medium-term results in one of the world's largest patient cohort after TCRAT surgery.  

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