{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:21:09Z","timestamp":1780471269780,"version":"3.54.1"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Total coronary revascularization via anterior thoracotomy (TCRAT) enables complete anatomical revascularization without sternotomy; however, data on its impact on left ventricular function remain limited. This study compared left ventricular functional outcomes between TCRAT and median sternotomy coronary artery bypass grafting (MS-CABG) in 554 patients undergoing elective isolated CABG at four centers (January 2020\u2013January 2025) with preoperative and \u22653-month follow-up echocardiography. Patients were grouped as TCRAT (n = 241) or MS-CABG (n = 313). Stabilized inverse probability of treatment weighting was applied to reduce selection bias, achieving adequate covariate balance (all standardized mean differences &lt; 0.10). The primary endpoint was follow-up left ventricular ejection fraction, assessed using IPTW-weighted analysis of covariance adjusted for preoperative values. No significant difference was observed between groups (\u03b2 = 0.13; 95% CI, \u22120.63 to 0.90; p = 0.734). Adjusted left ventricular end-diastolic diameter was modestly higher in the MS-CABG group (\u03b2 = 0.57 mm; 95% CI, 0.17\u20130.98; p = 0.006), while end-systolic diameter was similar. TCRAT was associated with longer operative times but shorter intensive care unit and hospital stays, along with lower transfusion requirements. These findings suggest that there was no statistically significant difference in follow-up systolic function between the surgical approaches. Although a modest difference in LVEDD was identified, its clinical significance remains uncertain.<\/jats:p>","DOI":"10.3390\/jcdd13060244","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:17:31Z","timestamp":1780467451000},"page":"244","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Ventricular Remodeling After Total Coronary Revascularization via Anterior Thoracotomy Versus Conventional Coronary Artery Bypass Grafting"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5415-5812","authenticated-orcid":false,"given":"Vedat","family":"Aslan","sequence":"first","affiliation":[{"name":"Vocational School of Health Services, Toros University, Mersin 33140, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4628-6672","authenticated-orcid":false,"given":"Sefa","family":"Sural","sequence":"additional","affiliation":[{"name":"Vocational School of Health Services, Toros University, Mersin 33140, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4121-7068","authenticated-orcid":false,"given":"\u00d6zerdem","family":"\u00d6z\u00e7al\u0131\u015fkan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Medicalpark Hospital, Mersin 33200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6khan","family":"G\u00f6kaslan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Gaziantep Anka Hospital, Gaziantep 27590, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1056\/NEJMoa1602001","article-title":"Coronary-artery bypass surgery in patients with ischemic cardiomyopathy","volume":"374","author":"Velazquez","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1056\/NEJMoa1211585","article-title":"Strategies for multivessel revascularization in patients with diabetes","volume":"367","author":"Farkouh","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2862","DOI":"10.1093\/eurheartj\/eht330","article-title":"Coronary artery bypass grafting: Part 1\u2014The evolution over the first 50 years","volume":"34","author":"Head","year":"2013","journal-title":"Eur. Hear. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1177\/1556984519849126","article-title":"Complete coronary revascularization via left anterior thoracotomy","volume":"14","author":"Babliak","year":"2019","journal-title":"Innovations"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Demianenko, V., D\u00f6rge, H., and Sellin, C. (2026). The TCRAT technique (total coronary revascularization via left anterior thoracotomy): Renaissance in minimally invasive on-pump multivessel coronary artery bypass grafting?. J. Cardiovasc. Dev. Dis., 13.","DOI":"10.3390\/jcdd13010028"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1053\/j.semtcvs.2020.02.032","article-title":"Multivessel arterial revascularization via left anterior thoracotomy","volume":"32","author":"Babliak","year":"2020","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2","DOI":"10.21037\/jovs-22-2","article-title":"Multivessel minimally invasive on-pump direct coronary artery revascularization","volume":"9","author":"Babliak","year":"2023","journal-title":"J. Vis. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1055\/s-0042-1758149","article-title":"Early results of total coronary revascularization via left anterior thoracotomy","volume":"71","author":"Sellin","year":"2023","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.xjtc.2024.10.022","article-title":"Minimally invasive coronary artery bypass grafting via left anterior minithoracotomy: Setup, results, and evolution of a new surgical procedure","volume":"29","author":"Verevkin","year":"2024","journal-title":"JTCVS Tech."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1056\/NEJMoa1807365","article-title":"Myocardial viability and long-term outcomes in ischemic cardiomyopathy","volume":"381","author":"Panza","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e24162","DOI":"10.1002\/clc.24162","article-title":"Appropriate time for ejection fraction reassessment after revascularization in patients with left ventricular dysfunction for risk stratification of sudden cardiac death","volume":"47","author":"Wang","year":"2024","journal-title":"Clin. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1136\/bmj.323.7321.1123","article-title":"Statistics notes: Analysing controlled trials with baseline and follow-up measurements","volume":"323","author":"Vickers","year":"2001","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/HCO.0000000000000566","article-title":"Left ventricular function recovery after revascularization: Comparative effects of percutaneous coronary intervention and coronary artery bypass grafting","volume":"33","author":"Ngu","year":"2018","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/ejcts\/ezab122","article-title":"Incidence, determinants and clinical impact of left ventricular function recovery after surgical treatments for ischaemic cardiomyopathy","volume":"60","author":"Nakae","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0735-1097(02)01726-6","article-title":"Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction","volume":"39","author":"Allman","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.jacc.2013.05.033","article-title":"Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease","volume":"62","author":"Garcia","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1056\/NEJMoa2206606","article-title":"Percutaneous revascularization for ischemic left ventricular dysfunction","volume":"387","author":"Perera","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1056\/NEJMoa1403612","article-title":"Liberal or restrictive transfusion after cardiac surgery","volume":"372","author":"Murphy","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1016\/j.jacc.2016.01.073","article-title":"Inflammation as a driver of adverse left ventricular remodeling after acute myocardial infarction","volume":"67","author":"Westman","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1038\/nrcardio.2014.28","article-title":"The inflammatory response in myocardial injury, repair, and remodelling","volume":"11","author":"Frangogiannis","year":"2014","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e20230299","DOI":"10.21470\/1678-9741-2023-0299","article-title":"Left anterior mini-thoracotomy vs conventional sternotomy in on-pump multivessel coronary revascularization","volume":"40","author":"Sicim","year":"2025","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sellin, C., Laube, S., Demianenko, V., Balan, R., D\u00f6rge, H., and Benoehr, P. (2024). Renal outcome in patients undergoing minimally invasive total coronary revascularization via anterior minithoracotomy compared to full median sternotomy CABG. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185418"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Sural, S., Aslan, V., Mutlu, D., Yeral, N., Ozcaliskan, O., and Gokaslan, G. (2025). Comparison of postoperative atrial fibrillation after total coronary revascularization via left anterior thoracotomy and conventional median sternotomy CABG. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1697113"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/244\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:58:47Z","timestamp":1780469927000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcdd13060244"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13060244","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]}}}