Evolution of Coronary Artery Bypass Grafting: Conventional vs. Minimally Invasive Techniques – A Review

Coronary artery bypass grafting (CABG) has evolved substantially since its inception in the 1960s, transitioning from conventional median sternotomy with on-pump cardiopulmonary bypass to minimally invasive and robotic-assisted techniques. This review examines the comparative outcomes of conventional CABG versus minimally invasive direct coronary artery bypass (MIDCAB), totally endoscopic coronary artery bypass (TECAB), robotic-assisted procedures, and hybrid revascularization strategies. Representative literature data demonstrate that minimally invasive approaches offer shorter hospital stays, reduced intensive care unit (ICU) durations, decreased postoperative pain, and comparable graft patency rates, particularly for left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafts. Hybrid techniques, combining surgical LIMA grafting with percutaneous coronary interventions for non-LAD targets, provide a balanced strategy for multivessel disease. While conventional CABG remains the gold standard for complex and multivessel disease, minimally invasive techniques improve early recovery and patient satisfaction. Future directions include integration of robotics, artificial intelligence, and 3D preoperative planning to optimize patient-centered outcomes.