Minimally Invasive Endoscopic Surgery in Patients With Previous Cardiac or Thoracic Surgery

BACKGROUND: Minimally invasive, sternal-sparing techniques offer an alternative to conventional repeat sternotomy in patients with prior cardiothoracic surgery, aiming to achieve durable coronary revascularization while minimizing procedural risk. CASE SUMMARY: Between 2022 and 2025, six patients underwent redo minimally invasive endoscopic-assisted coronary artery bypass grafting (Endo-CAB) with endoscopically harvested graft conduits, and a beating-heart anastomosis on the left anterior descending artery was made through a mini-thoracotomy. This case series presents patients with diverse prior cardiac and thoracic surgical histories. Although percutaneous coronary intervention was considered because of the increased operative risk, a minimally invasive surgical approach was preferred given unfavorable coronary anatomy and advanced atherosclerosis. All patients had an uneventful postoperative recovery. DISCUSSION: Redo Endo-CAB avoids repeat sternotomy, reduces surgical trauma, and facilitates a safe internal mammary artery harvest. This approach combines the durability of surgical revascularization with reduced perioperative morbidity in selected high-risk patients. TAKE-HOME MESSAGE: Redo Endo-CAB is a viable and promising revascularization strategy for selected patients with prior cardiothoracic surgery when performed at experienced centers.