The hybrid approach, with minithoracotomy or thoracoscopy, is feasible and it might increase the safety in the most challenging TLE procedures: the minimally invasive surgical intervention allows for continuous monitoring of the critical cardiac structures and prompt treatment of potential complications.

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The use of arterial conduits is associated with incremental benefits when compared to conventional CABG surgery, albeit there is a paucity of data regarding the long-term outcomes of either techniques. Among 973 consecutive patients undergoing CABG, a propensity-match study was performed to compare total arterial revascularization technique (G1) with a conventional approach (LITA on LAD plus additional SVGs, G2). The study population was propensity-matched based on preoperative characteristics (age, sex, risk factors). Mean number of grafted vessels (G1 = 2.39 ± 0.55 vs G2 = 2.37 ± 0.7; p = 0.79) and aortic cross-clamp time (G1 = 36 ± 6 vs G2 = 35 ± 6 min; p = 0.31) were similar while CPB time was significantly longer in Group 2 (G1 = 50 ± 7 vs G2 = 70 ± 8 min; p = 0.03). Hospital mortality (G1 = 0.6 % vs G2 = 1.3 %; p = 0.41) and overall incidence of postoperative complications were also comparable. Cox regression analysis depicted conventional CABG as an independent predictor for MACCEs (HR = 4.53, CI 95 % = 2-10.28; p < 0.001). Median follow-up time was 112 months: actuarial survival free from cardiac death (G1 = 100 % vs G2 = 95 ± 2.1 %; p = 0.046) and MACCEs (G1 = 97.3 ± 1.5 % vs G2 = 79.4 ± 3.8 %; p < 0.001) was significantly improved in patients undergoing total arterial grafting. Total arterial myocardial revascularization is associated with significantly improved outcomes at 10 years follow-up in terms of cardiac-related mortality and overall event-free survival.

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