Feasibility and Outcomes of Nonsternotomy, Off-Pump, Minimally-Invasive Multivessel CABG: Results from a Single-Center Cohort

All articles of this category (opens in new window) Background: Minimally invasive coronary artery bypass grafting (MICS CABG) without sternotomy has emerged as an alternative to conventional surgery. However, data on off-pump approaches in multi-vessel disease are still scarce, and evidence on long-term outcomes in larger patient cohorts remains limited. Methods: We retrospectively reviewed all consecutive patients who underwent multi-vessel MICS CABG at our institution between December 2014 and May 2025. Baseline characteristics were obtained from hospital records, and follow-up data were collected using postal questionnaires or phone interviews. Categorical variables are presented as counts and percentages, and continuous variables as mean ± standard deviation. The primary endpoints were 30-day mortality and long-term survival, the latter assessed using the Kaplan–Meier method. Results: A total of 181 patients were included in the analysis. The mean age was 66.8 ± 8.9 years, and 86.2% of patients were male. Hypertension was present in 94%, and three-vessel disease in 68% of patients. Mean left ventricular ejection fraction was 56.2 ± 11.3%, and mean EuroSCORE was 3.6 ± 2.9. Off-pump surgery was performed in 96.7% of cases, and cardiopulmonary bypass was needed in 6 of 181 patients (3.31%). Mean procedural duration was 223 ± 62 minutes. Two grafts were placed in 85.6% of patients, and ≥ 3 grafts in 14.4%.The observed 30-day mortality was 1.1%, markedly lower than the predicted by EuroSCORE, resulting in an observed-to-expected mortality ratio of 0.31. Kaplan–Meier survival was 96.5% at 3 years, and 94.9% at 5 years. Conclusion: Multi-vessel MICS-CABG using an off-pump, nonsternotomy approach is feasible and associated with excellent early outcomes and favorable long-term survival. These results support minimally invasive strategies as safe alternatives to conventional CABG in selected patients with multi-vessel coronary artery disease. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany