Background High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR).

Methods A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk. In high-risk patients with MVD undergoing MIDCAB or HCR, the incidence of major adverse cardiac and cerebrovascular events (MACCEs) after 30 days and during midterm follow-up was evaluated.

Results Out of 1,250 patients undergoing MIDCAB at our institution between 1998 and 2015, 78 patients (logES: 18.5%; age, 76.7 ± 8.6 years) met the inclusion criteria. During the first 30 days, mortality and rate of MACCE were 9.0%; early mortality was two-fold overestimated by logES. Complete revascularization as scheduled was finally achieved in 64 patients (82.1%). Median follow-up time reached 3.4 (1.2–6.5) years with a median survival time of 4.7 years. Survival after 1, 3, and 5 years was 77, 62, and 48%.

Conclusion In high-risk patients with MVD, MIDCAB is associated with acceptable early outcome which is better than predicted by logES. Taking the high-risk profile into consideration, midterm follow-up showed satisfying results, although scheduled HCR was not realized in a relevant proportion. In selected cases of MVD, MIDCAB presents an acceptable alternative for high-risk patients.

背景 多支血管疾病 (MVD) 包括左前降支复杂狭窄的高危患者可能不是通过冠状动脉旁路移植术 (CABG) 进行指南顺应性治疗的理想人选，考虑到侵入性和围手术期并发症。然而，他们可能受益于微创直接冠状动脉搭桥 (MIDCAB) 移植和混合血运重建 (HCR)。

方法 心脏手术风险评估评分 (logES) > 10% 的欧洲逻辑系统定义为高风险。在接受 MIDCAB 或 HCR 的 MVD 高危患者中，评估了 30 天后和中期随访期间主要不良心脑血管事件 (MACCE) 的发生率。

结果 1998 年至 2015 年期间，在我们机构接受 MIDCAB 的 1,250 名患者中，78 名患者（logES：18.5%；年龄，76.7 ± 8.6 岁）符合纳入标准。前 30 天，MACCE 的死亡率和发生率为 9.0%；logES 将早期死亡率高估了两倍。64 名患者（82.1%）最终按计划完成了完全血运重建。中位随访时间达到 3.4 (1.2-6.5) 年，中位生存时间为 4.7 年。1、3 和 5 年后的存活率为 77%、62% 和 48%。

结论 在高危 MVD 患者中，MIDCAB 与可接受的早期结果相关，优于 logES 预测。考虑到高风险情况，中期随访显示出令人满意的结果，尽管预定的 HCR 没有按相关比例实现。在选定的 MVD 病例中，MIDCAB 为高危患者提供了可接受的替代方案。