Introduction Postoperative atrial fibrillation (POAF) remains one of the most common complications following coronary artery bypass grafting (CABG), including minimally invasive cardiac surgery-CABG (MICS-CABG). The ligament of Marshall (LOM), containing myocardial fibres and rich autonomic innervation, has been implicated in atrial arrhythmogenesis. Despite evidence that catheter ablation targeting the LOM or surgical interruption during conventional CABG can be effective, prophylactic surgical excision of the LOM during MICS-CABG has not been evaluated in randomised controlled trials (RCTs).Methods and analysis The Ligament of Marshall Excision for the Prevention of Postoperative New-Onset Atrial Fibrillation (LOMEX-AF) trial is a single-centre, prospective, triple-blind (participants, outcome assessors, statisticians) RCT. Adults 30–80 years scheduled for elective MICS-CABG who meet inclusion/exclusion criteria will be randomised to Standard MICS-CABG with posterior left pericardiotomy (control) or the same procedure plus excision of a segment of the LOM (intervention). Resected tissue will be fixed for histopathology. Primary outcome: new-onset POAF during index hospitalisation defined as atrial fibrillation or atrial flutter lasting ≥30 s detected by ECG/telemetry. Secondary outcomes include frequency and duration of episodes, need for Class I/III antiarrhythmics or electrical cardioversion, intensive care unit and hospital length of stay, mechanical ventilation time and reoperation for bleeding. Sample size: 340 per arm (n=680 total) to detect a 50% relative reduction from an estimated 17% control event rate with 90% power, two-sided α=0.05, allowing 5% attrition. Primary analysis: intention-to-treat; categorical comparisons by χ² or Fisher exact test; continuous variables by t-test or Mann-Whitney U as appropriate; analyses performed in R.Ethics and dissemination The study has been approved by the institutional ethics committee of Peking University Third Hospital, Beijing, China (IRB00006761-M20250847. 11 October 2025). Written informed consent will be obtained from all participants before enrolment. The trial will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice principles and applicable national regulations. The findings will be disseminated through publication in peer-reviewed journals and presentation at academic conferences.Trial registration number ChiCTR2500110913.

OBJECTIVE:The objective of this study is to evaluate the safety, feasibility, and mid-term outcomes of using the left axillary artery (AXA) as an alternative inflow source for the proximal anastomosis of the saphenous vein graft (SVG) in MICS-CABG, focusing on intraoperative graft haemodynamics, early patency, and clinical outcomes. METHODS:We retrospectively analyzed consecutive patients who underwent MICS-CABG between April 2020 and August 2025 at a single center. Patients were divided into two groups based on the inflow source: the ascending aorta (n = 292) or the left axillary artery (n = 90). After propensity score matching, 80 matched pairs were analyzed. Intraoperative graft haemodynamics were assessed. Early graft patency was evaluated using coronary angiography or CT angiography. Mid-term outcomes, including overall survival and major adverse cardiac and cerebrovascular events (MACCEs), were compared between groups. RESULTS:Both groups demonstrated comparable intraoperative hemodynamic performance. The AXA group demonstrated an early graft occlusion rate comparable to that of the AOR group (1.32% vs. 3.16%, RR = 0.42, 95% CI = 0.08-2.11, and p = 0.45). Overall survival (93.2% vs. 100%, p = 0.06) and the MACCE-free metric (91.9% vs. 92.1%, p = 0.83) showed no significant difference between groups. CONCLUSIONS:The left axillary artery is a safe and feasible alternative inflow source in MICS-CABG. This approach provides acceptable intraoperative flow dynamics, early patency, and mid-term outcomes to conventional ascending aortic inflow.

Septic cardiomyopathy (SCM) is a severe complication of sepsis. The therapeutic potential of Ginsenoside Rh4 (Rh4) in SCM remains unclear. This study aimed to investigate the effects and mechanisms of Rh4 on SCM using both in vivo and in vitro approaches. In the in vivo experiments, Rh4 significantly reduced the mortality rate in SCM mice, improved ejection fraction and diastolic function, and protected myocardial cell mitochondria, thereby alleviating myocardial cell injury. Transcriptomic sequencing, ELISA, and PCR results suggested that Rh4 reduced inflammatory cytokines in myocardial tissues, likely through the inhibition of the NF-κB signaling pathway. This effect was associated with a reduction in pro-inflammatory M1 macrophages and an increase in the proportion of reparative M2 macrophages. Additionally, Rh4 alleviated myocardial cell apoptosis and attenuated myocardial fibrosis at later stages. In vitro, we found that Rh4 reduced LPS-induced macrophage polarization and promoted the polarization of macrophages into anti-inflammatory M2 macrophages. Moreover, flow cytometry analysis revealed that Rh4 decreased reactive oxygen species (ROS) production in HL-1 cardiomyocytes, with the mechanism linked to the activation of the Keap1/Nrf2/HO-1 signaling pathway. Finally, Rh4 treatment significantly inhibited the pro-apoptotic effects of LPS on HL-1 cells. In conclusion, Rh4 improves heart function by reducing macrophage polarization and ROS generation, protecting myocardial cell mitochondria, and reducing myocardial cell apoptosis.

BackgroundThis study aimed to evaluate the clinical efficacy, safety, and transcriptomic mechanisms of Fuzheng Yangxin Formula (FZYX) for enhanced recovery after coronary artery bypass grafting (CABG) in patients with Qi-Yin deficiency syndrome.MethodsThis prospective cohort study utilized 1:1 propensity score matching (PSM). Matched patients (n = 144; 72/group) received a 7-day FZYX intervention plus conventional therapy or conventional therapy alone. Assessments included the Seattle Angina Questionnaire Physical Limitation (SAQ-PL) score at 7 days, peak serum creatinine (Cr), B-type natriuretic peptide (BNP), and perioperative complications. Transcriptomic mechanisms were explored via peripheral blood RNA sequencing.ResultsPost-intervention, the FZYX group demonstrated significantly lower peak Cr (68.50 vs. 74.50 μmol/L, unadjusted p = 0.010; adjusted p = 0.0059 via ANCOVA) and peak BNP (751.00 vs. 1231.50 pg/mL, p = 0.019). Although the difference in absolute SAQ-PL scores did not reach statistical significance for superiority (40.00 vs. 35.56, p = 0.055), the FZYX group exhibited a markedly reduced quartile coefficient of dispersion (11.1% vs. 20.0%), indicating a trend towards a more stable physical recovery.ConclusionFZYX appears to be a safe and promising adjunctive therapy post-CABG. While the primary endpoint was formally negative, exploratory analyses suggest it may provide target organ protection and stable physical recovery, potentially associated with modulating macrophage/monocyte-driven innate inflammation, promoting adaptive immune reconstitution, and accelerating tissue repair.Clinical trial registrationIdentifier NCT06961136, https://clinicaltrials.gov/study/NCT06961136

Background: Although early safety of minimally invasive coronary artery bypass grafting (MICS-CABG) is validated, concerns regarding long-term clinical durability and survival relative to conventional sternotomy persist. The study aims to evaluate 10-year survival and major adverse cardiac and cerebrovascular events (MACCE) of MICS-CABG. Methods: An ambispective cohort was assembled by retrospectively identifying consecutive patients who underwent isolated CABG between November 2015 and March 2019, with prospective follow-up initiated in 2020 under a standardized protocol. Propensity-score matching (1:1) yielded 244 pairs (n=488 total). The primary endpoint was 10-year survival. Secondary endpoints included MACCE (death, myocardial infarction, stroke, or repeat revascularization). Results: In the matched cohort (median follow-up, 93 months), MICS-CABG was associated with superior 10-year survival compared with sternotomy-CABG (85.9% vs. 66.9%; log-rank P<0.001). The 10-year MACCE rate reduced in the MICS-CABG group [26.2% vs. 43.6%; hazard ratio (HR): 0.60; 95% confidence interval (CI): 0.43-0.83; P=0.002]. Crucially, there was no significant difference in the incidences for stroke (8.0% vs. 14.5%; P=0.21), myocardial infarction (4.5% vs. 5.4%; P=0.51), or repeat revascularization (6.0% vs. 4.3%; P=0.52). Survival analysis revealed that the mortality benefit was driven primarily by attenuated non-cardiac mortality (8.2% vs. 19.1%; P<0.001). Conclusions: MICS-CABG was associated with higher 10-year survival rate and reduced MACCE risk compared with sternotomy-CABG, without compromising long-term clinical durability. The survival benefit was predominantly driven by reduced non-cardiac mortality which suggest that sternal-sparing approach may preserve physiological reserve, thereby enhancing patient resilience against systemic stressors.

Following myocardial infarction (MI), the accumulation of CD86-positive macrophages in the ischemic injury zone leads to secondary myocardial damage. Precise pharmacological intervention targeting this process remains challenging. This study engineered a nanotherapeutic delivery system with CD86-positive macrophage-specific targeting and ultrasound-responsive release capabilities. A folic acid (FA)-modified ultrasound-responsive gene/drug delivery system, assembled from DOTAP, DSPE-PEG2000-FA, cholesterol, and perfluorohexane (PFH)-termed FA-PNBs-was developed to codeliver small interfering RNA of STAT1 (siSTAT1) and the small-molecule nitro-oleic acid (OA-NO2) into CD86-positive macrophages. Upon irradiation with low-intensity focused ultrasound, FA-PNBs release siSTAT1 and OA-NO2 at the ischemic injury zone. The results demonstrated the system's precise targeting and efficient delivery capabilities. The combined modulation of OA-NO2 and siSTAT1 optimizes the immune microenvironment in the infarcted region, alleviates ventricular remodeling, preserves cardiac function, and holds promise for clinical intervention strategies after MI.

Minimally invasive coronary artery bypass grafting (MIDCAB) requires effective left lung isolation, yet evidence comparing video-imaging single-lumen tracheal tubes with bronchial blockers (VSLT + BB) and vedio-imaging double-lumen endotracheal tubes (VDLT) remains limited. This randomized controlled trial aimed to: (1) quantitatively compare time efficiency for device placement and lung isolation between VSLT + BB and VDLT; (2) evaluate perioperative airway complications; and (3) assess differential impacts on postoperative recovery, including postoperative sore throat, hoarseness, and Quality of Recovery-15 (QoR-15) scores. In this single-blind randomized controlled trial, 97 MIDCAB patients were allocated to VSLT + BB or VDLT groups. Primary outcomes were tube positioning time; secondary outcomes included total intubation time, oxygenation parameters, hemodynamic variables, and postoperative complications. VDLT exhibited shorter tube positioning time (128 ± 37 vs. 159 ± 58 s; p < 0.001) but longer total intubation time (192 ± 40 vs. 159 ± 58 s; p < 0.001). VSLT + BB demonstrated higher PaO₂ at 10-min post-OLV (226.0 vs. 168.0 mmHg; p = 0.035) with lower airway pressures (p < 0.05). Postoperative sore throat (33

Continuous intercostal nerve block (ICNB) has been shown to offer effective pain relief after minimally invasive direct coronary artery bypass (MIDCAB). The erector spinae plane block (ESPB) could represent a viable alternative approach. This study aimed to compare the analgesic effect of programmed intermittent bolus(PIB) for ESPB to ICNB in patients undergoing MIDCAB. A prospective, open-label, randomized controlled trial was conducted. Eighty patients scheduled for MIDCAB were randomized into two groups (n = 40 per group). ESPB using a PIB injection was performed in the ESPB group, while ICNB was performed in the ICNB group. The primary outcome was numerical rating scale (NRS) pain scores at movement immediately after extubation. Secondary outcomes included the cumulative area under the curve (AUC) of the pain scores, perioperative analgesic consumption, adverse events and recovery data. A total of 73 patients were included in the modified intention-to-treat analysis and 71 patients in the per-protocol analysis. There was no significant difference in numeric rating scale (NRS) scores at rest or movement between the two groups immediately after extubation, at 8, 24 and 48 h. The cumulative area under the curve (AUC) of the time NRS curve until 48 h after extubation and the necessity of rescue analgesics did not differ to a statistically significant degree between the two groups. Compared with the ICNB group, the ESPB group had significantly lower usage of intraoperative sufentanil (93.8 ± 33.6 vs. 128.9 ± 48.4 µg; p = 0.001). Postoperative analgesic effect between ESPB and ICNB did not differ in patients after MIDCAB. Chinese Clinical Trial Registry (ChiCTR1900022388, retrospectively registered on Apr 09, 2019).

OBJECTIVE:Robotic-assisted harvesting of bilateral internal thoracic arteries offers significant advantages, and bilateral internal thoracic arteries grafting improves outcomes. This study retrospectively examined early clinical outcomes and follow-ups of patients who underwent robotic-assisted coronary artery bypass grafting with in situ bilateral internal thoracic arteries as a standardized technique in a single center. METHODS:Between April 2021 and June 2024, 369 consecutive patients underwent robotic-assisted coronary artery bypass grafting at our center, including 221 (59.9%) with in situ bilateral internal thoracic arteries. Skeletonized bilateral internal thoracic arteries harvesting was performed using a robotic system, followed by off-pump hand-sewn distal anastomoses accessed via a 4- to 6-cm left thoracotomy. A radial artery was harvested in 63 patients (28.5%) as a third conduit, forming a composite I-graft. Angiography was performed before discharge to confirm graft patency. The primary end points were major adverse cardiac/cerebrovascular events and all-cause mortality. RESULTS:Among 221 patients, the number of grafts was 2, 3, and 4 or more vessels in 124 patients (56.1%), 64 patients (29.0%), and 33 patients (14.9%), respectively. Hybrid therapy was performed in 9 (4.1%) cases. There was 1 (0.5%) conversion to peripheral cardiopulmonary bypass, no sternotomy conversions, and 1 (0.5%) postoperative death. Perioperative morbidity included 12 (5.5%) transfusions and 10 (4.5%) reexplorations for bleeding or revascularization. The postoperative graft angiography was performed on 216 patients (97.7%) and revealed an overall graft patency rate of 97.1% (545/561). The 12-month survival was 98.5%, with major adverse cardiac/cerebrovascular event-free survival at 97.1%. CONCLUSIONS:Robotic-assisted coronary artery bypass grafting with in situ bilateral internal thoracic arteries is a safe, effective, and minimally invasive alternative to sternotomy coronary artery bypass grafting, achieving total arterial revascularization and potentially improving long-term survival.

Background Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) has emerged as a safe alternative to standard cardiac surgery. However, treatment preferences can decrease the generalizability of RCT results to the clinical population (i.e., reduce external validity) and influence adherence to the treatment protocol and study outcomes (i.e., reduce internal validity). However, this has not yet been properly investigated in randomized trials with consideration of treatment preferences. Study Design In this study, patients with a preference will be allocated to treatment strategies accordingly, whereas only those patients without a distinct preference will be randomized. The randomized trial is a 248-patient controlled, randomized, investigator-blinded trial. It is designed to compare whether treatment with MICS-CABG is beneficial in comparison to CABG. This study is aimed to establish the superiority hypothesis for the physical component summary (PCS) accompanied by the non-inferiority hypothesis for overall graft patency. Patients with no treatment preference will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoints are the PCS score at 30 days after surgery and the overall patency rate of the grafts within 14 days after surgery. Secondary outcome measures include the PCS score and patency rate at different time points. Safety endpoints include major adverse cardiac and cerebrovascular events, complications, bleeding, wound infection, death, etc. Conclusions This trial will address essential questions of the efficacy and safety of MICS-CABG. The study will also address the impact of patients' preferences on external validity and internal validity.

Objectives The study sought to explore the characteristics and outcomes of patients undergoing clinically indicated minimally invasive cardiac surgery—coronary artery bypass grafting (MICS-CABG) and off-pump coronary artery bypass for MICS-CABG eligible multivessel disease, to inform the design of a confirmatory comparative effectiveness trial. Methods Over 30 months, 245 MICS-CABG and 158 off-pump coronary artery bypass participants were enrolled. Health-related quality-of-life was assessed using the 36-Item Short-Form Health Survey and Seattle Angina Questionnaire. The primary end point was the score on the physical component summary and mental component summary subscale of the 36-Item Short-Form Health Survey (on which scores range from 0 to 100, with higher scores indicating better health status). Results The score on the Physical Component Summary-United States subscale of the 36-Item Short-Form Health Survey increased to a greater extent with MICS-CABG than with off-pump coronary artery bypass at both 7 and 30 days (P = .002 and P = .001, respectively), as well as Physical Component Summary-Hong Kong subscale (MICS-CABG and off-pump coronary artery bypass: P = .002 and P < .001, respectively). The mental component summary subscale of the 36-Item Short-Form Health Survey in either the United States or Hong Kong and all 5 domains of Seattle Angina Questionnaire score were similar between the 2 groups throughout the follow-up period. Conclusions MICS-CABG, an emerging modality for treating multivessel coronary disease, yields an improved 7- and 30-day physical function than off-pump coronary artery bypass. Moreover, both strategies resulted in similar significant relief from angina over 12 months. A randomized controlled trial is warranted to compare the efficacy of these 2 revascularization strategies. (Prospective Cohort Study on Minimal Invasive Coronary Surgery: NCT04267835).

Background:Despite sternum sparing and without cardiopulmonary bypass, the actual value of minimally invasive coronary surgery (MICS) is still debatable. This study aimed to compare the completeness of revascularization and intermediate-term outcomes of MICS with conventional sternotomy coronary artery bypass grafting (CABG). Methods:Two groups of 244 patients each receiving MICS-CABG and sternotomy-CABG between November 2015 and March 2019 were matched by propensity score matching. The completeness of revascularization and major adverse cardiovascular and cerebrovascular events (MACCE; a composite of death, myocardial infarction, stroke, or repeated target vessel revascularization) were compared between the groups. Results:In the MICS-CABG group, the percentages of bypassed vessels 2, 3, and ≥4 were 53.7%, 36.1%, and 10.2%, respectively. Completeness of revascularization (95.5% vs 96.3%; P = .65) was comparable between MICS-CABG and sternotomy-CABG groups. Postprocedural angiography revealed an overall patency of 96.2% (578/601) for the MICS-CABG group. At 5 years, rates of MACCE (19.9% vs 22.1%; hazard ratio [HR], 0.80; 95% CI, 0.49-1.32; P = .39), death (10.6% vs 12.9%; HR, 0.87; 95% CI, 0.46-1.65; P = .67), myocardial infarction (5.6% vs 4.2%; HR, 0.82; 95% CI, 0.27-2.52; P = .73), stroke (6.7% vs 6.6%; HR, 1.11; 95% CI, 0.43-2.86; P = .83), and repeated target vessel revascularization (1.9% vs 1.8%; HR, 0.85; 95% CI, 0.17-3.15; P = .84) were similar between MICS-CABG and sternotomy-CABG. Conclusions:MICS-CABG, which appeared to yield noninferior completeness of revascularization and intermediate-term MACCE compared with sternotomy-CABG, could be an alternative for patients with multivessel coronary diseases.

Objective To evaluate early clinical outcomes of minimally invasive cardiac surgery-coronary artery bypass grafting（MICS CABG） using multi-arteries via left chest small incision. Methods Clinical data of 123 cases of off-pump multi-arterial CABG from January 2018 to December 2020 in our department were retrospectively analyzed. According to the needs of the patient and the tendency of the surgeon, the median incision（median incision group, n=51） or left chest small incision（left chest small incision group, n=72） was applied. Coronary CT or coronary angiography were used to evaluate the bypassing vessels before discharge, and early follow-up was performed after operation. The end point of follow-up was major adverse cardiac and cerebrovascular event（MACCE） and repeated revascularization. Results There were（2.7±0.7） distal anastomoses in the left chest small incision group and（3.0±0.8） in the median incision group, without significant difference（t=-1.885, P=0.062）. The left chest small incision group had a higher ratio of total arterial revascularization [91.7%（66/72） vs. 41.2%（21/51）, χ~2=36.762, P=0.000] and less perioperative transfusion [31.9%（23/72） vs. 64.7%（33/51）, χ~2=12.920, P=0.000] than the median incision group. One patient dead in the median incision group due to myocardial infarction. A total of 100 patients underwent coronary CT anteriography before discharge, including 30 in the median incision group and 70 in the left chest small incision group. A total of 280 grafts were reviewed, and there were no significant differences in overall graft patency rate（FitzGibbon grade A） between the two groups [94.2%（179/190） vs. 94.4%（85/90）, χ~2=0.006, P=0.937]. A total of 118 patients received follow-ups with a median of 24 months（range, 6-36 months）, and the incidences of MACCE [2.9%（2/70） vs. 6.3%（3/48）, χ~2=0.808, P=0.369] and repeated revascularization [2.9%（2/70） vs. 2.1%（1/48）, χ~2=0.000, P=1.000] were not significantly different between the two groups. Conclusions MICS CABG using multi-arteries is a feasible alternative. The surgical strategy is more inclined to perform total arterial bypass grafting. The graft patency rate and early follow-up results are all not inferior to median incision surgery, with MICS CABG being associated with less transfusion.

目的 探讨颈动脉狭窄合并冠状动脉狭窄患者行同期颈动脉内膜切除术(CEA)联合冠状动脉旁路移植术(CABG)后脑灌注的变化情况,分析脑灌注变化的相关因素.方法 回顾性分析2014年9月至2021年3月在北京大学第三医院神经外科连续收治的35例颈动脉狭窄合并冠状动脉狭窄患者的临床资料,包括性别、年龄、既往史(吸烟、高血压病、糖尿病等)、术前实验室检查结果(血清N末端B型钠尿肽前体、三酰甘油、总胆固醇和高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、空腹血糖等)、影像学资料[包括CT血管成像(CTA)及头部CT灌注(CTP)成像、颈动脉超声、超声心动图及冠状动脉造影等检查]及治疗情况.所有患者同期行CEA+CABG.术前和术后行头颈动脉CTA及头部CTP成像检查,以脑血流量(CBF)代表脑灌注情况,计算手术前后术侧和对侧相对脑血流量(rCBF)及CBF变化率(DRCBF),通过Pearson相关性分析探讨脑灌注变化的相关因素.结果 头部CTP成像示,术前术侧CBF为(19.4±2.2)ml/(100 g·min),对侧CBF为(24.4±4.7)ml/(100 g·min),rCBF为0.52～1.00,平均0.82±0.17;术后术侧CBF为(24.6±2.8)ml/(100 g·min),对侧CBF为(28.1±5.7)ml/(100 g·min),rCBF为0.68～1.35,平均0.90±0.16;与术前比较,术后rCBF明显升高,差异有统计学意义(t=-8.194,P<0.01);DRCBF为4％ ～62％,平均(28±14)％.DRCBF与颈动脉狭窄率呈高度正相关(r=0.826,P<0.01),与颈动脉收缩期最大峰值流速(r=0.701,P<0.01)、左心室射血分数(r=0.602,P<0.01)、同型半胱氨酸水平(r=0.473,P<0.01)呈正相关,与术前rCBF呈负相关(r=-0.421,P<0.01).结论 颈动脉狭窄程度及心功能与颈动脉狭窄合并冠状动脉狭窄手术前后脑灌注改变相关,有待于大样本多因素分析进一步验证.

IntroductionPhysical activity (PA) can improve cardiac function, exercise capacity, and quality of life, in addition to reducing mortality by 20%–30% and preventing the recurrence of adverse cardiovascular events in patients following coronary artery bypass graft (CABG). However, PA levels are low in patients after CABG. This study intends to explore the mediating effect of kinesiophobia between self-efficacy and PA levels in patients following CABG.Methods and analysisThe proposed study constitutes a prospective, multicentre and cross-sectional study comprising 413 patients. Four teaching hospitals with good reputations in CABG will be included in the study. All of them are located in Beijing, China, and provide medical service to the whole country. This study will assess the following patient-reported outcome measures: demographic information, International Physical Activity Questionnaire-Long, Social Support Rating Scale, Cardiac Exercise Self-Efficacy Instrument, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and Tampa Scale for Kinesiophobia Heart.Ethics and disseminationThis study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of The Sixth Medical Centre of PLA General Hospital (approval number: HZKY-PJ-2022–2). All study participants will provide written informed consent. Findings from this study will be published in Chinese or English for widespread dissemination of the results.Trial registration numberChinese Clinical Trial Register, ChiCTR2100054098.

Objective To compare the clinical data of patients who underwent thoracoscopic or minimally invasive left internal thoracic artery（LITA） harvesting technique for coronary artery bypass grafting. Methods From January 2020 to June 2022, 38 patients underwent minimally invasive coronary artery bypass surgeries. LITA was harvested with thoracoscopic（n=18） or minimally invasive instruments（n=20）, respectively. There were no significant differences in age, left ventricular ejection fraction, and left ventricular end diastolic dimension between the two groups（P＞0.05）. In the thoracoscopic group, LITA was obtained with the thoracoscopic instrument, and the coronary artery bypass grafting was completed with the minimally invasive heart stabilizer through a small incision in the left anterolateral chest without cardiopulmonary bypass, including 16 cases of single bypass grafting between LITA and the anterior descending artery, and 2 cases of multi coronary artery bypass grafting. In the minimally invasive group, 20 patients underwent bypass grafting with the anterior descending artery after obtaining LITA through a small anterolateral chest incision under direct vision. Results Among the 18 cases in the thoracoscopic group, LITA was successfully obtained in 16 cases, conversion to a small intercostal incision to obtain LITA under direct vision was required in 1 case, and the distal end was injured when obtaining the blood vessels under the thoracoscope in 1 case, with vascular anastomosis completed after repair through a small intercostal incision under direct vision. In the minimally invasive group, 20 patients were successfully obtained LITA and underwent bypass grafting. Compared with the minimally invasive group, patients in the thoracoscopic group showed advantages in postoperative mechanical ventilation time（4.9±2.0 h vs. 6.5±2.3 h, t=-2.318, P=0.026） and postoperative hospital length of stay（4.5±0.9 d vs. 5.3±0.8 d, t=-2.859, P=0.007）. There were no differences in perioperative red blood cell transfusion and ICU length of stay（P＞0.05）. Postoperative coronary angiography or CTA showed 100% graft patency. Conclusion Thoracoscopic LITA harvesting shows comparable clinical result with minimally invasive technique and advantages in mechanical ventilation time and postoperative length of stay.