HYBRID REVASCULARIZATION WITHIN MIDCAB PANORAMA: LONG- TERM FOLLOW-UP LOOKING AT MINOTAUR

Introduction: Hybrid Coronary Revascularization (HCR) in the setting of minimally invasive direct coronary artery bypass (MIDCAB) constitutes an effective solution in myocardial revascularization, coniugating the best of both revascularization procedures. Data on antiaggregation management are still lacking. MINOTAUR trial aims at evaluate the feasibility of cangrelor as bridging therapy. Methods: From February 2013 to August 2024 a total of 2100 patients underwent surgical coronary artery revascularization at our institution, of whom, 103 (4.9%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N=85) or in combination with percutaneous coronary intervention to pursue a hybrid strategy (N=18, HCR group). All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting. Results: After a median follow-up of 80 months (range 3.1-155 months), the MIDCAB cardiac mortality has been 0%. Overall mortality was 3%, with one in-hospital death and two additional late deaths. Conversion to sternotomy happened in 2 patients (1.9%) and surgical re- explorations occurred in 5 patients (4.8%), of whom three for bleeding and two for graft failure. In the HCR group, 13 patients (72%) received percutaneous revascularization (PCI) after MIDCAB, with a mean of 1.6 ± 0.6 treated vessels and 2.2 ± 0.9 drug-eluting stents implantation. The last 3 patients were enrolled in the MINOTAUR trial. Conclusions: MIDCAB, isolated or in association with HCR is associated with encouraging mid- and long-term results, in selected patients presenting multivessel disease and discussed within a dedicated heart-team. The MINOTAUR trial will define the best approach to manage the antiaggregation strategy.