Concomitant Liwen procedure and minimally invasive direct coronary artery bypass via a single access: a first-in-human case report

Background Advances in anaesthesia and minimally invasive surgical techniques have expanded therapeutic options for patients with complex cardiac disease. While conventional open-heart surgery carries significant risks for this population, hybrid strategies offer a viable alternative. Case summary We report the first case of concurrent hypertrophic obstructive cardiomyopathy (HOCM) and coronary artery disease (CAD) treated with a one-stage hybrid strategy: combining the Liwen procedure (echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation) with minimally invasive direct coronary artery bypass (MIDCAB) via a single access. This approach effectively addressed both left ventricular outflow tract obstruction and myocardial ischaemia, while reducing trauma and accelerating recovery. Discussion This case demonstrates that the concomitant Liwen procedure and MIDCAB through a single minimally invasive access is a feasible and promising strategy for patients with coexisting HOCM and CAD, offering reduced trauma and faster recovery compared to traditional approaches.