Perioperative Outcomes of Multivessel Minimally Invasive Coronary Revascularization at a Specialized Center: A Retrospective Cohort of Complete Surgical and Planned Hybrid Strategies.

Background: Multivessel minimally invasive coronary revascularization combines surgical myocardial revascularization through a left mini-thoracotomy with, in selected patients, a planned hybrid percutaneous component. Evidence from contemporary single-center cohorts remains limited. Methods: We retrospectively analyzed 180 Heart Team-selected patients treated with a multivessel minimally invasive strategy at the Department of Cardiac Surgery, University Hospital Bonn, between December 2021 and February 2025. The cohort comprised complete surgical revascularization and planned hybrid strategies. Results: Complete surgical revascularization was documented in 121/180 patients (67.2%), while 59/180 (32.8%) underwent planned hybrid revascularization. No in-hospital deaths occurred (0.0%; exact 95% CI, 0.0-2.0%). Stroke occurred in 2/180 (1.1%), re-thoracotomy for bleeding in 3/180 (1.7%), wound infection in 3/180 (1.7%), and AKI in 8/180 (4.4%). Three patients received postoperative dialysis; two were dialysis-dependent before surgery and one required new postoperative renal replacement therapy (0.6%). Postoperative atrial fibrillation was documented in 7 patients (3.9%). Post-discharge follow-up information was available for 140/180 patients (77.8%), with three recorded deaths. Conclusions: This cohort demonstrates that a Heart Team-driven multivessel minimally invasive coronary revascularization program incorporating both complete surgical and planned hybrid strategies can be implemented with favorable observed perioperative outcomes in carefully selected patients. At the same time, the results should not be interpreted as evidence that MV-MIDCAB or hybrid coronary revascularization is superior to conventional CABG.