关键词: 微创技术, 冠状动脉旁路移植术, 分期杂交, 全动脉化血运重建

Abstract: Objective： To compare the safety and effectiveness of two minimally invasive approaches for multi-vessel coronary revascularization. Methods: From August 2014 to February 2017, 70 consecutive patients who underwent minimally invasive coronary artery bypass grafting in Peking University Third Hospital were randomly divided into two groups. In one group, 40 patients underwent staged-hybrid coronary revascularization (staged-HCR) treatment; in the other group, 30 patients underwent minimally invasive total arterial revascularization with bilateral internal thoracic artery (BITA). In staged-HCR group, the patients underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) procedure for treatment of multi-vessel disease. In BITA group, the patients underwent total arterial coronary artery bypass grafting with composite “Y” BITA graft. Preoperative and postoperative data of the two groups, including postoperative blood usage, mechanical ventilation time, domiciling duration in intensive care unit (ICU), major adverse cerebral and cardiovascular event (MACCE), and postoperative coronary angiography results were compared, in order to evaluate the safety and effectiveness of these surgical approaches. Results: The preoperative characteristics of 70 patients in the two groups showed no significant difference. All the patients underwent successfully, elective minimally invasive multi-vessel coronary artery bypass grafting as scheduled preoperatively. Postoperative result showed the patients in staged-HCR group took advantages in less postoperative mechanical ventilation time ［Staged-HCR group (11.2±8.7) h vs. BITA group (18.3±9.1) h, P=0.013］, shorter domiciling duration in ICU ［StagedHCR group (26.29±4.05) h vs. BITA group (44.74±28.75) h, P=0.022］, and less total drainage ［Staged-HCR group (695.57±250.46) mL vs. BITA group (1 103.26±547.44) mL, P=0.03］ than the patients in the group of minimally invasive total arterial revascularization with BITA. Postoperative in hospital coronary angiography showed satisfactory graft patency rates in both groups ［97.5% in Staged-HCR group vs. 97.8% in BITA group］. No MACCE occurred in both groups during hospitalization. Conclusion: Staged-HCR is a feasible method for the treatment of multi-vessel revascularization involving right coronary artery. Minimally coronary revascularization with BITA is associated with superior long-term graft patency and it’s recommended for patients who could not tolerate dual-antiplatelet therapy. This study shows that both minimally invasive surgical approaches are safe and effective for treatment of patients with multi-vessel coronary artery disease.

Key words: Minimally invasive approach, Coronary artery bypass grafting, Staged coronary artery revascularization, Total arterial revascularization