Background: The impact of obesity on outcomes following minimally invasive direct coronary artery bypass (MIDCAB) and multivessel MIDCAB (MV-MIDCAB) remains incompletely understood. Methods: This retrospective, single-centre analysis included 383 patients with available body mass index (BMI) data: 275 non-obese patients (BMI < 30 kg/m²) and 108 obese patients (BMI ≥ 30 kg/m²). Propensity score matching based on available preoperative covariates yielded 105 matched pairs. Baseline balance was assessed using standardized mean differences (SMDs). Results: Multivessel MIDCAB was performed in 41.9% of obese and 44.8% of non-obese patients (p = 0.755), while complete revascularization was achieved in 32.4% and 33.3%, respectively (p = 1.000). Acute kidney injury occurred in 6.7% of obese and 3.8% of non-obese patients (p = 0.549), while postoperative delirium occurred in 8.7% and 5.7%, respectively (p = 0.581). Wound infection was documented in 3 obese patients (2.9%) and 1 non-obese patient (1.0%; risk difference, 1.9 percentage points; approximate 95% confidence interval [CI], −1.8 to 5.7; exact paired p = 0.625). In-hospital mortality occurred in 1 obese patient and no non-obese patients (risk difference, 1.0 percentage point; approximate 95% CI, −0.9 to 2.8; exact paired p = 1.000). Conclusions: No statistically significant differences in early outcomes were detected.

Background: Multivessel minimally invasive coronary revascularization combines surgical myocardial revascularization through a left mini-thoracotomy with, in selected patients, a planned hybrid percutaneous component. Evidence from contemporary single-center cohorts remains limited. Methods: We retrospectively analyzed 180 Heart Team-selected patients treated with a multivessel minimally invasive strategy at the Department of Cardiac Surgery, University Hospital Bonn, between December 2021 and February 2025. The cohort comprised complete surgical revascularization and planned hybrid strategies. Results: Complete surgical revascularization was documented in 121/180 patients (67.2%), while 59/180 (32.8%) underwent planned hybrid revascularization. No in-hospital deaths occurred (0.0%; exact 95% CI, 0.0–2.0%). Stroke occurred in 2/180 (1.1%), re-thoracotomy for bleeding in 3/180 (1.7%), wound infection in 3/180 (1.7%), and AKI in 8/180 (4.4%). Three patients received postoperative dialysis; two were dialysis-dependent before surgery and one required new postoperative renal replacement therapy (0.6%). Postoperative atrial fibrillation was documented in 7 patients (3.9%). Post-discharge follow-up information was available for 140/180 patients (77.8%), with three recorded deaths. Conclusions: This cohort demonstrates that a Heart Team-driven multivessel minimally invasive coronary revascularization program incorporating both complete surgical and planned hybrid strategies can be implemented with favorable observed perioperative outcomes in carefully selected patients. At the same time, the results should not be interpreted as evidence that MV-MIDCAB or hybrid coronary revascularization is superior to conventional CABG.