Inclusion Criteria:

• Age 60 years or older.

• Diagnosis of coronary artery disease with an established indication for coronary artery bypass grafting.

• Coronary anatomy considered suitable for complete surgical revascularization through a left anterolateral minithoracotomy, including suitable distal coronary targets with a luminal diameter of at least 1.5 mm.;

  > Alternatively, coronary anatomy suitable for a planned hybrid revascularization strategy, with coronary territories not treated surgically considered amenable to percutaneous coronary intervention.

• Presence of pre-frailty or frailty, defined by at least 2 of the following Fried frailty criteria:

  • Unintentional weight loss of at least 4.5 kg or at least 5% of body weight during the previous year.
  • Self-reported exhaustion or fatigue.
  • Reduced handgrip strength.
  • Slow walking speed.
  • Low level of physical activity.

• Ability and willingness to provide written informed consent.

Exclusion Criteria:

• Requirement for emergency cardiac surgery.
• Planned concomitant cardiac surgical procedure in addition to coronary artery bypass grafting.
• Clinically significant peripheral vascular disease involving the femoral vessels that prevents safe peripheral cannulation for cardiopulmonary bypass, when peripheral cannulation may be required.
• Contraindication to left minithoracotomy, including pleural adhesions, pleural thickening, or other thoracic conditions that prevent safe access to the mediastinum through the intercostal space.
• Severe chronic obstructive pulmonary disease or another pulmonary condition that prevents safe single-lung ventilation or temporary compression of the left lung.