Objective: To compare the efficacy of off-pump minimally invasive cardiac surgery (MICS) via a single left intercostal space incision with median sternotomy multi-vesselcoronary artery bypass grafting (CABG). Methods: Patients who were diagnosed with multi-artery coronary artery disease (CAD) in the Ward 10 of the Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University and underwent CABG from July 2019 to January 2022 were retrospectively collected. All the patients were divided into MICS group and conventional CABG group according to the surgical methods. The perioperative outcomes were compared between thetwo groups, including intraoperative blood loss, postoperative 24 h thoracic drainage volume, ventilation duration, length of stay (LOS) in intensive care unit (ICU) and total LOS in hospital. Intraoperative blood flow of graft vesselswas measured by transit-time flow measurement (TTFM) after vascular anastomosis, and mean flow (MF) and pulsatile index (PI) were compared between the two groups. Results: A total of 444 patients were in the final analysis, with 351 males and 93 females, and the mean age of (62.0±8.9) years. There were 179 patients in MICS group and 265 cases in conventional CABG group, respectively. There were no statistically significant differences in the preoperative profiles between the two groups (all P>0.05) except that younger age [(60.7±9.3) years vs (62.8±8.5) years, P=0.017] and lower proportion of female [10.1% (18/179) vs 28.3% (75/265), P<0.001] were detected in MICS group. Likewise, there was no significant difference in the number of graft vessels between MICS group (3.18±0.74) and conventional CABG group (3.28±0.86) (P=0.234). Compared with those in conventional CABG group, patients in MICS group showed longer operation duration [ (5.10±1.09) h vs (4.33±0.86) h], fewer intraoperative blood loss [500 (200, 700) ml vs 700 (600, 900) ml], fewer postoperative 24 h thoracic drainage volume [300 (200, 400) ml vs 400 (250, 500) ml], shorter postoperative ventilation duration [15.0 (12.0, 17.0) h vs 16.5 (12.5, 19.0) h, P<0.001], LOS in ICU [18.0 (15.0, 20.0) h vs 20.0 (16.0, 23.0) h, P<0.001] and total LOS in hospital [(12.6±2.7) d vs (14.5±3.9) d, P<0.001]. MI and PI of graft vessels were similar between the two groups (both P>0.05). Moreover, there were no significant differences in major perioperative complications (i.e., repeat thoracotomy, incision infection, stroke) and mortality between the two groups (all P>0.05). Conclusion: MICS is an alternative treatment for patients with multi-vessel CAD with better perioperative outcomes compared with conventional CABG.
目的： 比较非体外循环左侧肋间小切口微创与胸骨正中切口冠状动脉旁路移植术（CABG）（传统CABG）对多支冠状动脉病变的疗效。 方法： 回顾性分析2019年7月至2022年1月于首都医科大学附属北京安贞医院心脏外科十病区住院诊断为多支病变冠心病行CABG的患者临床资料，根据手术方式分为左侧肋间小切口微创CABG（MICS）组和传统CABG组。比较两组患者的围手术期结果，包括术中出血、术后24 h胸腔引流量、术后机械通气时间、重症监护病房（ICU）停留时间及总住院时间。术中应用即时血流测量技术对旁路血管进行血流测量，比较两组患者旁路血管的平均血流量（MI）和搏动指数（PI）。 结果： 共纳入444例患者，男351例，女93例，年龄（62.0±8.9）岁。MICS组179例，传统CABG组265例。与传统CABG组比较，MICS组女性比例较低［10.1%（18/179）比28.3%（75/265），P<0.001］，年龄较小［（60.7±9.3）岁比（62.8±8.5）岁，P=0.017），其他临床特征两组比较差异均无统计学意义（均P>0.05）。MICS组与传统CABG组患者旁路血管数量差异无统计学意义［（3.18±0.74）支比（3.28±0.86）支，P=0.234］，但MICS组患者手术时间较传统CABG组长［（5.10±1.09）h比（4.33±0.86）h，P<0.001］。与CABG组比较，MICS组患者术中出血量［500（200，700）ml比700（600，900）ml，P<0.001］、术后24 h胸腔引流量［300（200，400）ml比400（250，500）ml，P<0.001］均较少，术后机械通气时间［15.0（12.0，17.0）h比16.5（12.5，19.0）h，P<0.001］、术后ICU停留时间［18.0（15.0，20.0）h比20.0（16.0，23.0）h，P<0.001］、总住院时间［（12.6±2.7）d比（14.5±3.9）d，P<0.001］均较短。两组患者术后各旁路血管MI和PI差异均无统计学意义（均P>0.05）。两组患者围手术期主要并发症（包括再次开胸、切口感染、脑卒中）及病死率差异均无统计学意义（均P>0.05）。 结论： 与传统CABG比较，MICS是多支病变冠心病患者的一种有益的治疗选择，围手术期结局良好。.