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Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, primarily due to atherosclerotic plaque buildup that narrows coronary arteries and impairs myocardial blood flow. Traditional treatment through coronary artery bypass grafting (CABG), especially using the left internal thoracic artery (LITA) to the left anterior descending artery (LAD), offers excellent long-term results but is invasive and associated with significant perioperative risks.

Percutaneous coronary intervention (PCI) offers a less invasive alternative with faster recovery, but its long-term effectiveness is limited, especially in complex or multivessel disease. Robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) is an innovative surgical technique that enables LITA-LAD grafting without sternotomy, leading to shorter hospital stays, faster recovery, and fewer complications.

Hybrid coronary revascularization (HCR) combines RA-MIDCAB for LAD lesions with PCI for non-LAD vessels, achieving complete revascularization while avoiding cardiopulmonary bypass. Clinical outcomes of both RA-MIDCAB and HCR are promising, with high graft patency and reduced need for repeat procedures.

In the Netherlands, RA-MIDCAB and HCR have been in use since 2015, showing excellent survival and low reintervention rates. However, adoption remains limited due to the technical complexity and lack of guideline endorsement. Upfront costs are higher, but are offset by faster recovery and reduced complications.

Future research should focus on refining patient selection, simplifying techniques through innovation, and evaluating long-term outcomes and cost-effectiveness. RA-MIDCAB and HCR represent transformative advances in CAD management, combining the durability of surgical revascularization with the benefits of minimally invasive approaches.