Total Coronary Revascularization by Anterior Thoracotomy
A sternum-sparing approach to complete coronary revascularization through an anterior thoracotomy — avoiding median sternotomy in appropriately selected patients.
What is TCRAT?
Total Coronary Revascularization by Anterior Thoracotomy (TCRAT) is an advanced minimally invasive approach to coronary artery bypass surgery performed through an anterior thoracotomy rather than a traditional median sternotomy.
In carefully selected patients, this allows complete coronary revascularization while reducing surgical trauma, improving cosmesis, and supporting faster recovery compared with full sternotomy in appropriate cases.
TCRAT is part of a contemporary MICS programme and is taught at MICS India Academy alongside ERAS protocols and other minimally invasive coronary techniques.
The TCRAT advantage
Sternum-sparing access
Avoids median sternotomy in selected patients, with a smaller chest incision.
Complete revascularization
Full coronary bypass can be achieved through a minimally invasive thoracotomy approach when anatomy permits.
Faster recovery potential
Less chest wall disruption may support reduced pain and quicker return to activity when combined with ERAS.
Specialist technique
Requires dedicated MICS planning, imaging, and operative experience — available through structured training.
Who may be suitable for TCRAT?
Patient selection is essential. TCRAT is offered after detailed assessment of coronary anatomy, comorbidities, and surgical planning.
You may be a candidate if
- Coronary anatomy suitable for revascularization via anterior thoracotomy
- Elective or appropriately selected bypass candidates after multidisciplinary review
- Patients who may benefit from avoiding sternotomy when technically feasible
- Cases where conversion to sternotomy remains planned if required for safety
How TCRAT is performed
TCRAT combines minimally invasive access with rigorous bypass technique and myocardial protection.
- 1
Preoperative planning
Advanced imaging and angiography define targets, conduit strategy, and MICS feasibility.
- 2
Anterior thoracotomy
Coronary revascularization is performed through a left anterior thoracotomy without splitting the breastbone in selected cases.
- 3
Bypass & protection
Cardiopulmonary bypass, myocardial protection, and grafting follow established principles adapted to the MICS setting.
- 4
Recovery pathway
ERAS protocols support early mobilisation, pain control, and structured discharge planning.
Recovery after TCRAT
ICU and ward care with ERAS-focused early mobilisation and pain control.
Structured recovery with emphasis on breathing exercises and gradual activity.
Cardiac rehabilitation and follow-up with your surgical and cardiology team.
Tips for recovery
- Follow ERAS and surgeon guidance on activity and wound care.
- Attend all scheduled follow-up appointments.
- Report new chest pain, breathlessness, or wound concerns promptly.
Frequently asked questions
Discuss your options with an expert
Book a consultation with Dr. Vamshidhar Tirunagari to understand whether TCRAT is right for you.