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

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.

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.

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.

Redo Endo-CAB is a viable and promising revascularization strategy for selected patients with prior cardiothoracic surgery when performed at experienced centers.