{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:09:59Z","timestamp":1790244599322,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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\u20132.0%). 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.<\/jats:p>","DOI":"10.3390\/jcm15197424","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:07:54Z","timestamp":1790240874000},"page":"7424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Outcomes of Multivessel Minimally Invasive Coronary Revascularization at a Specialized Center: A Retrospective Cohort of Complete Surgical and Planned Hybrid Strategies"],"prefix":"10.3390","volume":"15","author":[{"given":"Veaceslav","family":"Ciobanu","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0573-8218","authenticated-orcid":false,"given":"Ihor","family":"Krasivskyi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Luca","family":"Pizzulli","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"}]},{"given":"Eissa","family":"Alaj","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9763-7304","authenticated-orcid":false,"given":"Marwan","family":"Hamiko","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Nadejda","family":"Monsefi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Farhad","family":"Bakhtiary","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Kaveh","family":"Eghbalzadeh","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_2","first-page":"e18","article-title":"2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Lawton","year":"2022","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jacc.2016.11.071","article-title":"Coronary artery bypass grafting with and without manipulation of the ascending aorta: A network meta-analysis","volume":"69","author":"Zhao","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.athoracsur.2024.04.010","article-title":"The current state of hybrid coronary revascularization","volume":"118","author":"Willard","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"Nashef","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Monsefi, N., Alaj, E., Sirat, S., and Bakhtiary, F. (2023). Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1051105"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Alaj, E., Seidiramool, V., Ciobanu, V., Bakhtiary, F., and Monsefi, N. (2024). Short-Term Clinical Results of Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Procedure. J. Clin. Med., 13.","DOI":"10.20944\/preprints202404.1618.v1"},{"key":"ref_8","unstructured":"(2012). Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int. Suppl., 2, 1\u2013138."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_10","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_11","doi-asserted-by":"crossref","first-page":"621","DOI":"10.21037\/acs.2018.06.14","article-title":"Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting","volume":"7","author":"Raja","year":"2018","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1055\/s-0043-1768035","article-title":"Five-Year Survival of Patients Treated with Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Compared with the General Swiss Population","volume":"72","author":"Reuthebuch","year":"2024","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/icvts\/ivy237","article-title":"Heart Team decision making and long-term outcomes for 1000 consecutive cases of coronary artery disease","volume":"28","author":"Domingues","year":"2019","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"219","DOI":"10.2217\/fca-2020-0244","article-title":"Hybrid coronary revascularization in multivessel coronary artery disease: A systematic review","volume":"18","author":"Nenna","year":"2022","journal-title":"Future Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E493","DOI":"10.1532\/hsf.2499","article-title":"Minimally Invasive CABG or Hybrid Coronary Revascularization for Multivessel Coronary Diseases: Which Is Best? A Systematic Review and Metaanalysis","volume":"22","author":"Guan","year":"2019","journal-title":"Heart Surg. Forum"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E61","DOI":"10.1532\/HSF98.20111141","article-title":"Review of a 13-year single-center experience with minimally invasive direct coronary artery bypass as the primary surgical treatment of coronary artery disease","volume":"15","author":"Holzhey","year":"2012","journal-title":"Heart Surg. Forum"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijcard.2022.04.030","article-title":"Hybrid coronary revascularization versus coronary artery bypass grafting for multivessel coronary artery disease: A systematic review and meta-analysis","volume":"359","author":"Dixon","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"ezae271","DOI":"10.1093\/ejcts\/ezae271","article-title":"Hybrid coronary revascularization: Position paper of the European Society of Cardiology Working Group on Cardiovascular Surgery and European Association of Percutaneous Cardiovascular Interventions","volume":"66","author":"Thielmann","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","first-page":"1182","article-title":"Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta-analysis of 14 studies comprising 4226 patients","volume":"100","author":"Nagraj","year":"2022","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5458064","DOI":"10.1155\/2020\/5458064","article-title":"Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year\u2014Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS)","volume":"2020","author":"Ganyukov","year":"2020","journal-title":"J. Interv. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1016\/j.jcin.2014.05.025","article-title":"POL-MIDES Study Investigators. Hybrid revascularization for multivessel coronary artery disease","volume":"7","author":"Zembala","year":"2014","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/HCO.0000000000000223","article-title":"Current state and future direction of hybrid coronary revascularization","volume":"30","author":"Harskamp","year":"2015","journal-title":"Curr. Opin. 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