目的·比较微创多支冠状动脉旁路移植术（minimally invasive multivessel cardiac surgery-coronary artery bypass grafting，MICS-CABG）与杂交冠状动脉血运重建术（hybrid coronary revascularization， HCR）治疗多支冠状动脉疾病的围术期和近中期临床疗效，探讨其安全性和应用价值。方法·回顾性分析2020年1月至2023年6月在上海交通大学医学院附属瑞金医院心脏外科行微创冠状动脉搭桥术的123例患者的临床资料及随访结果。按照手术方式将患者分为MICS-CABG组（58例）和HCR组（65例）。对比2组基础资料［吸烟史、高血压、糖尿病、慢性阻塞性肺病（chronic obstructive pulmonary diseases，COPD）、脑梗史、心肌梗死史、经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）史、左心室射血分数（left ventricular ejection fraction，LVEF）、病变冠状动脉支数等］、围术期指标［外科手术时间、围术期有无输血、手术有无中转正中开胸、术中有无植入主动脉球囊反搏（intra-aortic balloon pump，IABP）、有无使用体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）、任何原因的二次手术、呼吸机使用时间、重症监护病房（intensive care unit，ICU）停留时间、住院时间、血运重建冠状动脉支数、术后24 h引流量、死亡、术后并发症等］。并于术后1、3、6、12个月及之后每隔6个月进行电话或门诊定期随访，随访主要终点为主要心脑血管事件（major adverse cardiac and cerebral events，MACCE），术后（12±3）个月行冠状动脉影像学检查，对比2组患者近中期MACCE事件及目标治疗血管的通畅情况。结果·MICS-CABG组患者外科手术时间显著长于HCR组（P<0.001），术后呼吸机使用时间更长（P=0.001），且术后早期呼吸衰竭发生率更高（32.76% vs 12.31%，P=0.007），但MICS-CABG组血运重建冠状动脉数更多（P=0.002）。MICS-CABG组患者术后24 h引流量更多（P<0.001），但2组术中术后输血患者比例差异无统计学意义（6.90% vs 1.54%，P=0.145）。除此之外，2组均无转正中开胸、未植入IABP、未使用ECMO，2组围术期心肌梗死、脑卒中、新发心房颤动、死亡、ICU停留时间、住院时间差异也无统计学意义。MICS-CABG组共吻合170支血管桥，其中左前降支（left anterior descending，LAD）桥血管58支，其余靶血管血管桥共计112支。HCR组共吻合65支血管桥（均为LAD），共行PCI完成血运重建冠状动脉90支。术后（12±3）个月影像学检查评估LAD桥血管通畅率，2组差异无统计学意义（93.10% vs 96.92%，P=0.601）；而对于非LAD靶血管血运重建后通畅情况，虽然MICS-CABG组略低于HCR组（91.96% vs 96.67%），但两者差异亦无统计学意义（P=0.190）。MICS-CABG组术后随访（30±22）个月，HCR组术后随访（31±16）个月，MACCE累积发生率均较低（0 vs 1.54%，P=0.325），再次血运重建率差异无统计学意义。结论·MICS-CABG和HCR这2种手术在治疗多支冠状动脉病变的围术期安全性和近中期临床疗效相当，但MICS-CABG手术时间更长、术后呼吸并发症风险更高，而HCR需严格评估PCI指征。临床应根据患者病变特点及心肺功能个体化选择术式。

Objective ·To compare the perioperative and short-to-medium-term clinical outcomes of minimally invasive multivessel cardiac surgery-coronary artery bypass grafting (MICS-CABG) and hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (CAD), and to evaluate their safety and clinical applicability. Methods ·A retrospective analysis was conducted on 123 patients who underwent minimally invasive coronary artery bypass surgery at the Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, between January 2020 and June 2023. Patients were divided into the MICS-CABG group (n=58) and the HCR group (n=65) based on the surgical approach. Baseline characteristics [smoking history, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), history of cerebral infarction, myocardial infarction, prior percutaneous coronary intervention (PCI), left ventricular ejection fraction (LVEF), number of diseased coronary vessels] and perioperative outcomes [operation time, perioperative transfusion, conversion to median sternotomy, intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) use, reoperation for any cause, mechanical ventilation duration, intensive care unit (ICU) stay, hospital stay, number of revascularized vessels, 24-hour postoperative drainage volume, mortality, and complications] were compared. Follow-up was conducted at 1, 3, 6, and 12 months postoperatively and every 6 months thereafter, with the primary endpoint being major adverse cardiac and cerebrovascular events (MACCE). Coronary imaging was performed at (12±3) months to assess graft/stent patency. Results ·The MICS-CABG group had a significantly longer operative time (P<0.001), a longer duration of mechanical ventilation (P=0.001), and a higher incidence of early postoperative respiratory failure (32.76% vs 12.31%, P=0.007) compared to the HCR group. However, the MICS-CABG group achieved more complete revascularization (P=0.002). Postoperative 24-hour drainage volume was greater in the MICS-CABG group (P<0.001), but transfusion rates did not differ significantly (6.90% vs 1.54%, P=0.145). Conversion to sternotomy, IABP implantation, and ECMO use were not required in either group. No significant differences were observed in perioperative myocardial infarction, stroke, new-onset atrial fibrillation, mortality, ICU stay, or hospital stay. In the MICS-CABG group, 170 grafts were anastomosed [58 left anterior descending (LAD) grafts and 112 non-LAD grafts], while the HCR group had 65 grafts (all LAD) and 90 PCI-treated vessels. At 1 year, LAD graft patency (93.10% vs 96.92%, P=0.601) and non-LAD target vessel patency (91.96% vs 96.67%, P=0.190) showed no significant differences. The MICS-CABG group patients were followed up for (30±22) months postoperatively, and the HCR group patients were followed up for (31±16) months postoperatively. MACCE rates were low in both groups (MICS-CABG 0 vs HCR 1.54%, P=0.325), with no significant difference in repeat revascularization. Conclusion ·MICS-CABG and HCR demonstrate comparable perioperative safety and short-to-medium-term efficacy in patients with multivessel CAD. While MICS-CABG requires a longer operative time and carries a higher risk of respiratory complications, HCR necessitates stringent PCI eligibility assessment. The choice of procedure should be individualized based on anatomical complexity and cardiopulmonary function.