摘要
目的比较骨骼化左乳内动脉（LIMA）序贯吻合于前降支系统及单纯吻合于前降支的近中期结果。方法复旦大学附属中山医院自2012年7月至2015年6月共完成123例骨骼化LIMA序贯吻合于对角支和前降支的冠状动脉旁路移植（CABG）手术，与同期1 474例骨骼化LIMA吻合于前降支的CABG手术的临床资料进行对比，通过倾向性评分匹配后，共纳入各120例患者，分为序贯组和对照组，对两组数据的临床资料进行对比分析。结果两组患者术前资料基本匹配，吻合口数量为3～6支，平均3.5支，91.3%（219/240）的患者接受非体外循环CABG（OPCAB）手术。两组患者围手术期资料具有可比性，序贯组与对照组患者术后死亡发生率均为1.7%（2/120），并发症发生率分别为5.0%（6/120）和5.8%（7/120），差异无统计学意义；序贯组LIMA主干流量高于对照组[（47±10）ml/min比（37±9）ml/min，P〈0.001]，差异有统计学意义。9例患者远期死亡，序贯组和对照组分别为4例和5例，远期死亡发生率差异无统计学意义[3.4%（4/116）比4.3%（5/115），P＝0.748]。5例患者接受再次血运重建，序贯组和对照组分别为2例和3例。多因素回归分析显示两组患者心血管不良事件率差异无统计学意义。随访冠状动脉CT造影结果显示，序贯组99.1%（115/116）对角支吻合口和98.3%（114/116）前降支吻合口完全通畅，对照组98.2%（111/113）前降支吻合口完全通畅，两组LIMA通畅率差异无统计学意义。结论骨骼化左乳内动脉可序贯吻合于前降支系统，近中期临床效果良好，乳内动脉近中期通畅率满意，远期结果尚待进一步随访。
ObjectiveTo evaluate in-hospital and mid-term outcomes of sequential versus separate grafting of in situ skeletonized left internal mammary artery （LIMA） to the left coronary system in a single-center, propensity-matched study.MethodsAfter propensity score matching, 120 pairs of patients undergoing first, scheduled, isolated coronary artery bypass grafting （CABG） with in situ skeletonized LIMA grafting to the left anterior descending artery （LAD） territory were entered into a sequential group （sequential grafting of LIMA to the diagonal artery and then to the LAD） or a control group （separate grafting of LIMA to the LAD）. The in-hospital and follow-up clinical outcomes and follow-up LIMA graft patency were compared.ResultsThe two propensity score-matched groups had similar in-hospital and follow-up clinical outcomes. The number of bypass conduits ranged from 3 to 6 （with a mean of 3.5）, and 91.3%（219/240）of the included patients received off-pump CABG surgery. No significant differences were found between the two propensity score-matched groups in the in-hospital outcomes, including in-hospital death and the incidence of complications associated with CABG （prolonged ventilation, peroperative stroke, re-operation before discharge, and deep sternal wound infection）. During follow-up, 9 patients （4 patients from the sequential group and 5 patients from the control group） died, and the all-cause mortality rate was 3.9%. No significant difference was found in the all-cause mortality rate between the 2 groups[3.4% （4/116） vs 4.3% （5/115）, P=0.748]. During follow-up period, 99.1% （115/116） patency for the diagonal site and 98.3% （114/116） for the LAD site were determined by coronary computed tomographic angiography after sequential LIMA grafting, both of which were similar with graft patency of separate grafting of in situ skeletonized LIMA to the LAD.ConclusionsRevascularization of the left coronary system using a skeletonized LIMA resulted in excellent in-hospital an
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第10期763-767,共5页
National Medical Journal of China
关键词
冠状动脉分流术
原位左乳内动脉
序贯吻合
骨骼化
Coronary artery bypass
In situ left internal mammary artery
Sequential grafting
Skeletonized
