Drug-Eluting Stents (DES) der neuesten Generation gelten als Goldstandard der interventionellen Behandlung von Koronarstenosen und sind in den aktuellen Leitlinien der Fachgesellschaften Therapie der Wahl für die interventionelle Revaskularisation von Koronarstenosen. Obwohl aktuelle DES einige Probleme und Nachteile der reinen Ballonangioplastie bzw. der Bare Metal Stents (BMS) gelöst haben, bleiben Limitationen, insbesondere die einer chronischen lokalen Entzündungsreaktion als Folge der permanenten Implantation eines Fremdkörpers, das Risiko einer späten und sehr späten Stentthrombose und eine Einschränkung der vaskulären Vasomotion durch das permanente Metallgerüst. Der Einsatz von bioresorbierbaren Scaffolds (BRS) könnte diese Limitationen überwinden, da sie lediglich temporär im Gefäß verbleiben und sich nach ca. 1–2 Jahren auflösen. Derzeit stehen 2 Devices zur klinischen Anwendung zu Verfügung. Darüber hinaus befinden sich einige in der Erprobung. Dieser Artikel gibt einen Überblick über den aktuellen Stand. New generation drug-eluting metal stents (DES) are the golden standard for percutaneous coronary intervention and the treatment of choice for revascularization of coronary artery stenosis in the current guidelines of the cardiac societies. Although modern DES have solved some of the problems and disadvantages of plain balloon angioplasty and bare-metal stents (BMS) some limitations remain, especially a chronical local inflammatory response as a result of permanent implantation of a foreign body, the risk of late and very late stent thrombosis and a missing vasomotion due to a permanent metal framework. The development of bioresorbable scaffolds is an approach that aims to overcome the limitations of drug-eluting metal stents. These devices provide temporary scaffolding of the vessel and then disappear, liberating the vessel from its cage. Currently, two devices are available for clinical use and various types of bioresorbable scaffolds are under development. This article provides an overview of the current state of development.

Background: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated favorable early and midterm results in unselected patients with coronary artery multivessel disease. However, safety and outcomes in elderly patients remain less well defined. Particularly in octogenarians with relevant comorbidities, data are scarce, and the role of TCRAT compared to conventional coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate in-hospital and midterm outcomes of TCRAT in patients aged ≥ 80 years. Method: From 11/2019 to 10/2025, CABG via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic arrest was performed as a routine procedure in 859 consecutive, nonemergency patients. Among them, 82 patients (9.5%) were octogenarians, all presenting with multivessel coronary artery disease. Results: In the group of octogenarians, mean BMI was 26.5 ± 3.1 kg/m², left ventricular ejection fraction was 49.2 ± 9.1% (range 20–55%), and mean EuroSCORE II was 5.1 ± 2.4. Comorbidities included diabetes mellitus (24.4%), chronic lung disease (7.3%), prior PCI (23.2%), and peripheral vascular disease (78.5%). The mean follow-up (100%) was 9.1 months. Left internal thoracic artery was used in 98.8% and radial artery was used in 43.9%. A mean of 3.0 ± 0.9 (range 2–5) anastomoses per patient was performed. Total operation time was 299 ± 64 min (range 164–480). In-hospital mortality was 1.2%, stroke rate was 1.2%, myocardial infarction rate was 0%, and repeat revascularization rate was 1.2%. At follow-up, all-cause mortality, myocardial infarction, repeat revascularization, and stroke were 4.9%, 0%, 2.4%, and 1.2%, respectively. The overall major adverse cardiac and cerebrovascular events rate (MACCE) was 7.3% at follow-up. Conclusion: TCRAT enables complete coronary artery revascularization in multivessel coronary artery disease without sternotomy and can be safely performed in octogenarians. Both in-hospital and midterm outcomes were favorable and comparable to reported contemporary outcomes of conventional CABG in elderly patients.

Background: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated favorable early and midterm results in unselected patients with coronary artery multivessel disease. However, safety and outcomes in elderly patients remain less well defined. Particularly in octogenarians with relevant comorbidities, data are scarce, and the role of TCRAT compared to conventional coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate in-hospital and midterm outcomes of TCRAT in patients aged ≥ 80 years. Method: From 11/2019 to 10/2025, CABG via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic arrest was performed as a routine procedure in 859 consecutive, nonemergency patients. Among them, 82 patients (9.5%) were octogenarians, all presenting with multivessel coronary artery disease. In this subgroup, mean BMI was 26.5 ± 3.1 kg/m², left ventricular ejection fraction was 49.2 ± 9.1% (range 20–55 %), and mean EuroSCORE II was 5.1 ± 2.4. Comorbidities included diabetes mellitus (24.4 %), chronic lung disease (7.3 %), prior PCI (23.2 %), and peripheral vascular disease (78.5 %). The mean follow-up (100 %) was 9.1 months. Results: Left internal thoracic artery was used in 98.8 %, radial artery was used in 43.9 %. A mean of 3.0 ± 0.9 (range 2-5) anastomoses per patient was performed. Total operation time was 299 ± 64 min (range 164 - 480). In-hospital mortality was 1.2 %, stroke rate was 1.2 %, myocardial infarction rate was 0 % and repeat revascularization rate was 1.2 %. At follow-up, all-cause mortality, myocardial infarction, repeat revascularization, and stroke was 4.9 %, 0 %, 2.4 %, and 1.2 %, respectively. Overall major adverse cardiac and cerebrovascular events rate (MACCE) was 7.3 % at follow up. Conclusion: TCRAT enables complete coronary artery revascularization in multivessel coronary artery disease without sternotomy and can be safely performed in octogenarians. Both in-hospital and midterm outcomes were favorable and comparable to contemporary outcomes of conventional CABG in elderly patients.