Background/Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) surgery, performed through a left minithoracotomy, has emerged as an alternative to conventional coronary artery bypass grafting (CABG), which requires a full sternotomy. This procedure is ideal for patients with isolated proximal left anterior descending (LAD) artery disease or high surgical risk. The aim of this study was to assess the long-term clinical outcomes of MIDCAB performed at a single center with stratification by revascularization strategy. Methods: A total of 480 patients who underwent off-pump MIDCAB between 2012 and 2024 at a single center were retrospectively analyzed and categorized into three distinct groups: complete revascularization (MIDCAB-CR), hybrid coronary revascularization (MIDCAB-HCR) and incomplete revascularization (MIDCAB-IR). Short- and long-term outcomes, including mortality, major adverse cardiac and cerebral events (MACCE) and LITA–LAD graft patency were evaluated. Median follow-up was 3.39 years. Results: In-hospital mortality was 1.4%. At a median follow-up duration of 3.39 years, the overall LITA–LAD graft patency was 94.4% with 5- and 10-year survival rates of 78% and 60%, respectively. MIDCAB-CR and MIDCAB-HCR groups showed comparable long-term survival and freedom from MACCE, both significantly better than those observed in the MIDCAB-IR groups. Conclusions: These findings support the safety and durability of MIDCAB as an effective revascularization strategy, especially when performed as complete or hybrid revascularization. Incomplete revascularization may be considered in selected high-risk patients but is associated with worse outcomes.

Background: Traditional cardiovascular risk models focus on patient-related clinical variables, while the impact of long-term environmental exposure remains insufficiently characterized in post-revascularization populations. Objective: To evaluate the association between environmental exposure and long-term mortality after coronary artery bypass grafting (CABG), and to determine whether integrated environmental measures provide additional prognostic value beyond established clinical risk factors. Methods: This retrospective multicenter cohort study included 1042 consecutive patients undergoing CABG with a median follow-up of 8.1 years. Regional environmental data were linked to individual patients. Multivariable Cox regression models were constructed using a hierarchical approach. To address collinearity among environmental variables, principal component analysis (PCA) was applied. Mean winter temperature was analyzed as a clinically interpretable proxy of overall environmental exposure. Results: During follow-up, 220 deaths (21.1%) occurred. Established clinical predictors of mortality included age, diabetes mellitus, peripheral vascular disease, and dyslipidemia. Individual environmental variables showed unstable associations due to collinearity. PCA identified a dominant environmental component explaining 82.0% of variance; however, its association with mortality did not reach statistical significance after adjustment (HR 1.17 per SD, 95% CI 0.98–1.39; p = 0.083). In contrast, higher mean winter temperature was independently associated with increased mortality (HR 1.24 per SD, 95% CI 1.05–1.48; p = 0.013) per 1 °C increase, with evidence of non-linearity. Conclusions: Environmental exposure represents a relevant component of long-term risk after CABG. While individual environmental variables are highly correlated and unstable, clinically interpretable measures such as winter temperature may provide practical support for risk assessment.

Vitamin K antagonists (VKAs) are essential for anticoagulation in patients with mechanical heart valves, but are affected by drug interactions, particularly with rifampicin - a potent inducer of CYP2C9 that accelerates VKA metabolism and destabilises INR levels. A 48-year-old male with multiple aortic valve replacements and infective endocarditis required rifampicin therapy post-surgery. Despite escalating doses of warfarin and acenocoumarol, therapeutic INR levels were not achieved, requiring low molecular weight heparin (LMWH) bridging. INR stabilisation occurred only after discontinuing rifampicin, with a drastic reduction in VKA dose requirements. Managing anticoagulation in patients on VKAs and rifampicin remains challenging due to rapid metabolism and INR fluctuations. Close INR monitoring, dose adjustments and alternative strategies, such as twice-daily VKA dosing or LMWH bridging, are crucial for maintaining therapeutic anticoagulation.