{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T18:28:14Z","timestamp":1788460094187,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"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>Background: Minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) through left anterior mini-thoracotomy avoids both extracorporeal circulation and sternotomy and is a very elegant, safe, and effective surgical technique, despite its still-limited adoption in the daily toolkit of cardiac surgeons. The goal of this retrospective, single-centre analysis was to evaluate the long-term outcomes of a large patient cohort undergoing MICS CABG. Methods: This study identified 597 consecutive MICS CABG patients from August 2008 to November 2020. We obtained follow-up data by phone or mail. Every patient had a left internal thoracic artery bypass graft. The second and possibly third grafts were radial arteries, great saphenous vein segments, or right internal thoracic arteries. Results: The median age was 69 years, and 92.1% were male. The median EuroSCORE II was 1.5. There were eight conversions to sternotomy and none to cardiopulmonary bypass. The total arterial revascularisation was 92.5%, with 90.3% complete. The 30-day mortality was 0.5%. A total of 575 patients (95.8%) were tracked for 8 years on average. A Cox regression analysis found that a left ventricular ejection fraction &lt; 50%, peripheral vascular disease, chronic kidney disease, and a history of cerebrovascular accident independently predicted severe adverse cardiac and cerebrovascular events and late death. The actuarial survival rates for one, three, five, eight, and ten years were 99%, 95%, 91%, 85%, and 80%, respectively. Conclusions: In our study group, the technique of MICS CABG has been proven to be a safe and effective surgical revascularisation method, with a low rate of early complications and favourable long-term outcomes in eligible patients.<\/jats:p>","DOI":"10.3390\/jcm14051707","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T03:26:21Z","timestamp":1741058781000},"page":"1707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Medium- and Long-Term Outcomes of 597 Patients Following Minimally Invasive Multi-Vessel Coronary Off-Pump Bypass Surgery"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0395-9834","authenticated-orcid":false,"given":"Magdalena I.","family":"Rufa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Ursulescu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Ahad","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragi","family":"Nagib","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihnea","family":"Ghinescu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tunjay","family":"Shavahatli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3104-6816","authenticated-orcid":false,"given":"Rafael","family":"Ayala","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7692-3480","authenticated-orcid":false,"given":"Nora","family":"G\u00f6bel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich F. W.","family":"Franke","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Centre Freiburg University, 79189 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-2172","authenticated-orcid":false,"given":"Bartosz","family":"Rylski","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/imi.0000000000000353","article-title":"Mid-term follow- up of minimally invasive multivessel coronary artery bypass grafting: Is the early learning phase detrimental?","volume":"12","author":"Rodriguez","year":"2017","journal-title":"Innovations"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1161\/CIRCULATIONAHA.108.840041","article-title":"Minimally invasive coronary artery bypass grafting: Dual-center experience in 450 consecutive patients","volume":"120","author":"McGinn","year":"2009","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jtcvs.2017.07.088","article-title":"Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future?","volume":"155","author":"Nambiar","year":"2018","journal-title":"J. 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