Minimally invasive surgical coronary artery revascularization- current status and future perspectives in an era of interventional advances

We are currently witnessing rapid advances in coronary artery disease (CAD) diagnostic- and treatment technology, which include exciting developments in the utilisation of artificial intelligence, stem cell and genetic therapy and pharmacological innovation that complement contemporary percutaneous coronary interventions (PCI) and patient preference for less invasive interventions. Progressive expansion of international CAD treatment guidelines with subsequent changes in referral patterns that favour less invasive interventions, increased patient expectations, industry driven marketing and an increasingly aging population with significant procedural risks, continue to re -define the role of conventional coronary artery bypass grafting (CABG) by sternotomy access in the treatment of CAD. However, the undisputed benefits of CABG over PCI in various clinical scenarios were recently re -confirmed and subsequently resulted in renewed interest in the development and application of less invasive surgical revascularization procedures. Reports by experienced minimally invasive surgical coronary artery revascularization (MISCAR) centres suggest shortand long-term outcomes that are comparable with conventional CABG and created an exciting platform for further MISCAR innovation while contributing to the global initiation of exciting upcoming MISCAR programs. This manuscript outlines the feasibility, current status and preliminary data of recent advances in contemporary CAD diagnostic- and therapeutic technology, provides and overview of the contemporary CAD revascularization decision -making evidence and describe the future perspectives of MISCAR in an era of rapid advances in less invasive CAD prevention-, diagnostic- and therapeutic technology. We trust that this overview will contribute to future research and changes in clinical practice.