Minimally Invasive Coronary Artery Bypass Grafting (MICS-CABG)

Minimally invasive coronary artery bypass grafting (MICS-CABG) has evolved substantially over the past three decades and now represents a meaningful alternative to conventional sternotomy CABG for selected patients with multivessel coronary artery disease. This review summarizes the historical development of minimally invasive coronary surgery, from early minimally invasive direct coronary artery bypass, video-assisted and port-access procedures, and endoscopic techniques to contemporary direct-vision MICS-CABG, robotic-assisted CABG, and totally endoscopic coronary artery bypass (TECAB). Current direct-vision approaches enable multivessel revascularization through a limited thoracotomy, supported by advances in bilateral internal thoracic artery harvesting and dedicated MICS instrumentation. Robotic-assisted CABG has further reduced surgical trauma by allowing endoscopic graft harvesting and hybrid revascularization strategies. TECAB represents the least invasive form of surgical coronary revascularization, although its dissemination has been limited by the lack of compatible instrumentation, discontinuation of automated anastomotic devices, and a steep learning curve.