Abstract: Objective · To summarize the experiences and follow-up results of minimally invasive direct coronary artery bypass (MIDCAB) for treating coronary atherosclerotic cardiopathy for 10 years and to evaluate the long-term effects of MIDCAB. Methods · The patients who underwent MIDCAB at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from February 2009 to May 2019 were collected. According to whether the patients achieved complete revascularization (CR) or underwent hybrid coronary revascularization (HCR), the cases were divided into 3 groups: incomplete revascularization (IR) + optimal medical therapy (OMT) group, MIDCAB (CR) group and HCR (CR) group. The Kaplan-Meier (K-M) curve was used to analyze the long-term survival and the freedom from major adverse cardiac and cerebrovascular events (MACCE) of patients. Results · A total of 425 patients were enrolled in the study, with a median follow-up of 39.9 months (18.2-81.1 months). The hospital stay in the HCR (CR) group was significantly prolonged compared with the other two groups (P=0.000). The perioperative mortality (P=0.000), perioperative myocardial infarction (MI) rate (P=0.000), perioperative MACCE rate (P=0.000), cardiac troponin I (cTnI) levels in 48 h (P=0.011), long-term mortality (P=0.000), long-term MI rate (P=0.002), and long-term MACCE rate (P=0.005) in the IR + OMT group were significantly higher than those in the other two groups of patients who had CR. The overall 10-year survival rate and freedom from MACCE estimated by K-M curves were 80.9% (95%CI 73.1%-88.7%) and 70.5% (95%CI 62.1%-78.9%), respectively. The long-term survival (P=0.000) and freedom from MACCE (P=0.001) in IR+OMT group were significantly lower than those in the other two groups. Conclusion · MIDCAB has good long-term effects on patients with coronary atherosclerotic cardiopathy. Patients undergoing MIDCAB should complete CR, and IR can significantly affect the long-term prognosis of patients.

Key words: minimally invasive direct coronary artery bypass, hybrid coronary revascularization, complete revascularization, coronary atherosclerotic cardiopathy