{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T12:10:51Z","timestamp":1775477451047,"version":"3.50.1"},"reference-count":16,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T00:00:00Z","timestamp":1727827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Minimally invasive, sternum-sparing total coronary revascularization in multivessel disease via left anterior mini-thoracotomy (TCRAT) was introduced recently. Intra-aortic balloon occlusion is a conceivable option to avoid manipulation of the ascending aorta, to reduce the risk of stroke and to be able to treat patients with severe calcifications and unfavorable aortic anatomies. Background\/Objectives: The aim of our study was to show that the use of the IntraClude\u00ae device, as part of minimally invasive coronary artery bypass grafting (CABG) via left anterior mini-thoracotomy, is feasible. Methods: From May to December 2023, CABG via left anterior mini-thoracotomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in 20 patients (17 male, 67.6 \u00b1 8.2 (51\u201382) years). All patients had significant coronary artery disease (three-vessel: n = 6; two-vessel: n = 11; one-vessel: n = 3) with indication for surgical revascularization. The mean EuroScore2 was 2.6. Results: All patients successfully underwent minimally invasive CABG using endo-aortic balloon occlusion. A total of 43 distal anastomoses (2.2 \u00b1 0.6 (1\u20133) per patient) were performed by using left internal artery mammary (n = 20) and radial artery (n = 14) for grafting the left anterior descending (n = 19), circumflex (n = 15) and right (n = 6) coronary artery. There was no hospital mortality, no stroke, no myocardial infarction or repeat revascularization. A total of 15 out of 20 patients left hospital within 8 days after surgery. Conclusions: TCRAT by using the IntraClude\u00ae device is feasible without compromising surgical principles while avoiding the external manipulation of the ascending aorta. The use of intra-aortic balloon occlusion instead of transthoracic clamps further reduces the invasiveness of the procedure.<\/jats:p>","DOI":"10.3390\/jcm13195891","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T06:27:31Z","timestamp":1727850451000},"page":"5891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Endo-Aortic Clamping with the IntraClude\u00ae Device in Minimally Invasive Total Coronary Revascularization via Left Anterior Thoracotomy (TCRAT)"],"prefix":"10.3390","volume":"13","author":[{"given":"Christian","family":"Sellin","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilmar","family":"D\u00f6rge","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parwis","family":"Massoudy","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94036 Passau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9687-1841","authenticated-orcid":false,"given":"Andreas","family":"Liebold","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Ulm University Hospital, 89081 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7340-7472","authenticated-orcid":false,"given":"Robert","family":"Balan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94036 Passau, Germany"},{"name":"I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1001\/jamainternmed.2013.12844","article-title":"Coronary artery bypass grafting vs percutaneous coronary intervention and long-term mortality and morbidity in multivessel disease: Meta-analysis of randomized clinical trials of the arterial grafting and stenting era","volume":"174","author":"Sipahi","year":"2014","journal-title":"JAMA Intern. 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