Objectives: Hybrid coronary revascularization (HCR), a revascularization strategy that amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI), represents a significant advancement in coronary artery disease treatment. This study compares conventional and robotic approaches in HCR. Methods: A systematic literature review and individual patient data analysis was conducted via PubMed following PRISMA guidelines, including original works published until 28 February 2025. Results: 32 publications met the inclusion criteria, providing individual data from 2,048 patients. All patients underwent MIDCAB for LAD lesions and perioperative PCI for non-LAD lesions. 903 patients (670 male, 233 female; mean age 51.69 ± 7.77 years; BMI 34.66 ± 13.13) were treated with robot-assisted HCR, whilst 1,145 patients (890 male, 255 female; mean age 69.62 ± 8.42 years; BMI 26.62 ± 1.30) underwent conventional HCR. The robot-assisted group showed significantly higher rates of right coronary artery (RCA) stenosis (18.60% vs. 16.07%, p = 0.004) and drug-eluting stent use (62.68% vs. 5.42%, p = 0.027), along with significantly shorter hospital stays (4.27 ± 1.34 vs. 10.27 ± 7.34 days, p = 0.001). Although not statistically significant, wound complications were more frequent in the robot-assisted cohort (0.66% vs. 0.09%), whereas pleural effusion (10.74% vs. 0.00%), pericardial effusion (0.61% vs. 0.11%), and pneumothorax (1.83% vs. 0.11%) were more frequent in the conventional group. Mortality was low in both cohorts (robotic vs. conventional): intra-operative (0% vs. 0.09%, p = 0.73), 30-day (0.44% vs. 0.70%, p = 0.82), follow-up (2.66% vs. 4.72%, p = 0.41). Conclusion: Hybrid coronary revascularization offers a less invasive alternative with potential benefits. Robotic assistance may enhance outcomes, but limited adoption and heterogeneous data underscore the need for further investigation and validation.

Background: The HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD) is the only commercially available option considered suitable for long-term circulatory support. External compression of the outflow graft causing obstruction (eOGO) is a serious adverse event affecting patients on long-term support. The obstruction occurs due to the accumulation of gelatinous substance between the bend relief and outflow graft. This systematic review evaluated all available studies with regard to the diagnosis and therapy of eOGOs. Methods: A systematic literature review and analysis of individual patient data was performed using MEDLINE/PubMed following PRISMA guidelines. Original works dating up to 31 October 2024 were considered. Results: Twenty-four publications that met the inclusion criteria were identified, providing individual data from 113 patients with a median support time to eOGO diagnosis of 809 days [588, 1095] and follow-up after treatment of 365 days [33, 605]. eOGO severity classification was performed on 108 patients according to our grading system. For treatment, most patients underwent surgery (n = 38) or stenting (n = 29). A hazard ratio of 0.75 [0.28, 2.03] was calculated for the surgical group versus the stenting group (p = 0.570). Conclusions: Concerning 30-day mortality, we did not find a significant difference between the eOGO severity of survivors and non-survivors. We found no significant differences in outcome between patients with differing eOGO severity and treatment strategy, namely stenting and surgery. Due to an increase in eOGO incidence after one year of support, we propose that clinicians monitor their patients for this complication when support time surpasses one year.

Background: Hybrid coronary revascularisation benefits patients with multivessel disease, as it amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI). Case summary: We present a 63-year-old female with triple-vessel coronary artery disease including marked ostial stenosis of the left main coronary artery, as well as moderate stenosis of the right coronary artery. The risk of death following heart surgery (EuroSCORE II) is 4.27%. The patient exhibited multiple morbidities including chronic obstructive pulmonary disease, renal impairment, extracardiac arteriopathy, and multiple prior gastrointestinal surgeries, as well as a recent episode of paroxysmal atrial fibrillation. A MIDCAB procedure without electrocoagulation was stipulated by the ENT specialist due to the patient’s cochlear implant. Conclusion: A successful MIDCAB procedure omitting electrocoagulation was performed for the first time for multivessel coronary disease in a multimorbid patient as part of a hybrid approach.

External outflow graft obstruction is an uncommon late complication in patients supported with a fully magnetically levitated left ventricular assist device. Progressive extrinsic compression of the outflow graft can impair pump performance and lead to symptomatic deterioration, requiring intervention to restore graft patency. This video tutorial presents a hybrid procedure combining surgical transaxillary access with endovascular stent implantation for treatment of external outflow graft obstruction when transfemoral access is not feasible. A 72-year-old woman with ventricular assist device support presented with exertional dyspnoea. Imaging demonstrated a persistent external narrowing of the outflow graft distal to the cannula, and invasive assessment confirmed a significant pressure gradient. Severe kinking of the femoral vessels excluded conventional femoral access. After induction of general anaesthesia, the axillary artery was exposed through an infraclavicular incision and accessed under direct vision. A vascular sheath was introduced, allowing retrograde advancement of guidewires across the stenotic graft segment. Two overlapping balloon-expandable covered stents were deployed under fluoroscopic guidance to restore luminal diameter and antegrade flow. Completion angiography confirmed satisfactory stent expansion and improved device flow.