Comparison of hybrid coronary revascularization and minimally invasive multivessel CABG for multivessel coronary artery disease

Background This study aimed to compare the perioperative and early-to-mid-term outcomes of hybrid coronary revascularization (HCR) and minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) for treating multivessel coronary artery disease (MVCAD). Methods We conducted a retrospective observational cohort study including MVCAD patients who underwent HCR or MICS-CABG at Ruijin Hospital between January 2019 and December 2024. The primary endpoint was the incidence of major perioperative complications within 30 days after surgery, including all-cause mortality, myocardial infarction (MI), and stroke. Secondary endpoints included 1-year all-cause survival and 1-year graft or target-vessel patency. Propensity score matching (PSM) was performed to reduce baseline imbalance between the two groups. Kaplan–Meier analyses were used to evaluate 1-year survival. Results A total of 169 patients were included, of whom 91 underwent HCR and 78 underwent MICS-CABG. After 1:1 PSM, 132 patients remained, with 66 patients in each group. Major perioperative complications within 30 days after surgery were comparable. In the HCR group, MI occurred in 1 patient (1.52% vs. 0.00%; P = 1.000), stroke in 2 patients (3.03% vs. 0.00%; P = 0.476), and death in 1 patient (1.52% vs. 0.00%; P = 1.000), whereas no such events occurred in the MICS-CABG group. The MICS-CABG group had significantly longer operative time (250 vs. 160 min, P < 0.001) and greater 24-hour postoperative drainage (420 vs. 185 mL, P < 0.001). Postoperative respiratory complications were numerically more frequent after MICS-CABG. The 1-year survival rate was comparable between the HCR and MICS-CABG groups after PSM (98.5% vs. 98.4%; log-rank P = 0.996). The 1-year left anterior descending artery (LAD) revascularization patency rate was comparable between the HCR and MICS-CABG groups (94.6% vs. 90.0%; P = 0.366), as was non-LAD target-vessel patency (86.5% vs. 87.0%; P = 0.922). Conclusions HCR and MICS-CABG provided comparable perioperative safety, early-to-mid-term survival, and 1-year revascularization patency in selected patients with MVCAD. Treatment strategy may be individualized according to coronary lesion characteristics and cardiopulmonary function.