目的·分析应用定量血流分数（quantitative flow ratio，QFR）技术指导冠状动脉外科血运重建策略的初步临床结果，探索其可行性与安全性。方法·纳入2018年1月—2019年6月上海交通大学医学院附属瑞金医院心血管外科行择期心脏外科手术的82例患者，对术前冠状动脉造影目测法提示狭窄≥50%的病变血管行QFR分析。QFR≤0.8判断为阳性，提示存在冠状动脉病变导致的心肌缺血，建议行冠状动脉旁路血管移植术（coronary artery bypass grafting，CABG）。对患者的基线资料、手术数据及初步临床结果进行总结。结果·82例患者共计174支冠状动脉接受QFR分析，其中53支血管（30.5%）为QFR阳性（≤0.8），其余121支（69.5%）为QFR阴性(>0.8)。根据QFR重新对血运重建进行决策后，39例（47.6%）患者的62支（35.6%）血管按原手术计划进行针对原发病的心脏外科手术和同期CABG。其余43例患者（52.4%）的112支（64.4%）血管改变了血运重建策略或未行CABG；其中15例（18.3%）单纯冠状动脉粥样硬化性心脏病患者免于任何手术而出院。接受手术的67例患者中，术后30 d内全因死亡2例（3.0%），新发肾功能衰竭行血液透析治疗4例，围术期心肌梗死1例，脑卒中1例，未观察到非计划再次血运重建，累计发生复合主要不良临床事件6例（9.0%）。结论·QFR指导冠状动脉外科血运重建是可行的和安全的，可以减少不必要的CABG，其有效性尚待进一步随访和前瞻性临床研究验证。

Objective · To analyze the feasibility, safety and preliminary clinical results of quantitative flow ratio (QFR)-guided surgical coronary revascularization. Methods · From Jan 2018 to June 2019 at the Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, patients undergoing elective cardiac surgery with any coronary stenosis ≥ 50%, evaluated by preoperative coronary angiography visualization, were enrolled consecutively. There were 82 patients with 174 coronary artery vessels. Coronary artery bypass grafting (CABG) was recommended with a QFR value ≤ 0.8. The data of baseline characteristics, surgical procedure and perioperative outcomes were collected and analyzed. Results · QFR analysis was successfully carried out in 82 patients and 174 coronary artery vessels. QFR was detected positive ( ≤ 0.8) in 53 vessels (30.5%) and negative (>0.8) in the remaining 121 vessels (69.5%). As guided with QFR, 39 patients (47.6%) with 62 vessels (35.6%) proceeded to surgery for primary heart disease with concomitant CABG as planned, while the remaining 43 patients (52.4%) with 112 vessels (64.4%) changed revascularization strategy or spared CABG. Fifteen patients with simple coronary artery disease avoided CABG and discharged. Among the remaining 67 patients operated on, there were 2 deaths, 4 hemodialysis for new renal failure, 1 perioperative myocardial infarction and 1 stroke within 30 d. No unplanned revascularization was observed. The composite adverse events occurred in 6 cases (9.0%). Conclusion · QFR-guided surgical coronary revascularization is feasible and safe. This strategy could reduce the unnecessary bypass grafting. Further follow-up and prospective clinical trials are warranted to evaluate the effectiveness.