Kolkata: Cardiac surgeons at a city hospital have pushed the traditional boundaries of minimally invasive cardiac surgery by performing a complex, four-graft Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) procedure on a 45-year-old patient.The surgery, conducted at BP Poddar Hospital, successfully revascularised all major coronary territories through a single small incision between the patient’s ribs, offering a landmark alternative to traditional open-heart surgery.The patient was diagnosed with advanced ischaemic heart disease affecting all three major coronary arteries, including the critical left anterior descending artery. Given the severity and distribution of the blockages, standard surgical protocols would typically dictate conventional open-heart bypass surgery via a sternotomy, allowing unrestricted open access to manoeuvre around the heart.Unlike traditional surgery, MICS CABG restricts visible access and instrument movement, making complex multivessel grafting — especially across distinct left and right coronary territories — exceptionally challenging.Overcoming these clinical constraints, Dr Md Rashid Zeya Ayubi, consultant CTVS surgeon, along with his team, completed all four grafts minimally. The team grafted the left internal mammary artery (LIMA) to the LAD, alongside a sequential reverse saphenous vein graft (RSVG) connected to the first diagonal branch (D1), second obtuse marginal branch (OM2), and right posterior descending artery (rPDA).“The revolution in MICS CABG is about removing limitations once considered inherent to minimally invasive surgery,” said Dr Ayubi. “This case challenged two major boundaries — the number of grafts and the coronary territories that could be reached. Completing four grafts across both coronary systems through minimal access shows how far MICS has evolved and how those boundaries can now be redefined.”Hospital leadership highlighted the clinical milestone as a significant step forward for cardiac care in the region.“We are conducting, on average, more than 100 MICS surgeries every month. But this particular four-graft procedure is not only a first for us, but probably also among the first of its kind in Eastern India,” said Supriyo Chakrabarty, Group adviser at B P Poddar Hospital. Four or more grafts account for only about 10% or fewer of all MICS CABG procedures performed globally.
