摘要
目的总结评估左前外侧小切口直视下应用全动脉化冠状动脉旁路移植(MICS-TACR)早期经验及临床价值。方法选取2015年5月至2018年6月在北京大学第三医院心脏外科完成左前外侧小切口获取双侧乳内动脉及桡动脉行MICS-TACR术连续性病例31例,男21例,女10例,年龄(63.2±9.3)岁。同期我院完成常规正中切口非体外循环冠状动脉旁路移植(OPCABG)1 489例,经过排除标准筛选及匹配性评分,选取90例作为对照组,男55例,女35例,年龄(63.8±9.5)岁。比较两组围手术期资料。对全部小切口手术患者术后早期复查造影,评价桥血管通畅率情况。结果匹配后两组患者性别、年龄、合并症、心功能分级等基线资料差异均无统计学意义(均P>0.05)。MICS-TACR组围手术期红细胞使用少于OPCABG组[0(0,0)U比0(0,4)U,Z=-2.976,P=0.003],两组患者在手术死亡率、术中及术后主动脉内球囊反搏(IABP)及体外膜肺氧合(ECMO)、再次手术率、围手术期主要心脑血管事件(MACCE)、新发肾功能衰竭、新发房颤、多器官功能衰竭比例差异均无统计学意义(均P>0.05)。复查造影结果显示,全部动脉桥血管非闭塞率(Fitzgibbon A+B级)达到98.5%,其中左乳内动脉及右乳内动脉桥通畅率为100%。结论经左前外侧小切口直视下可成功完成MICS-TACR术,近期临床效果良好。
Objective To summarize the early experience and clinical value of minimally invasive coronary surgery-total arterial coronary revascularization (MICS-TACR) through the left anterior small incision. Methods Between May 2015 and June 2018, a total of 31 consecutive cases [21 males and 10 females, aged (63.2±9.3) years] in Peking University Third Hospital who were performed MICS-TACR with bilateral internal mammary artery and radial artery were enrolled. Meanwhile, 1 489 cases of conventional median sternal incision off-pump coronary artery bypass grafting (OPCABG) were matched as control group. According to exclusion criteria and matching score, 90 cases [55 males and 35 females, aged (63.8±9.5) years] were selected as the control group, and the perioperative data of the two groups were compared. All patients in MICS-TACR group underwent postoperative angiography and the graft patency was evaluated. ResultsThere were no statistically significant differences in baseline data between the two groups. The perioperative blood transfusion of MICS-TACR group was less than control group [0(0,0) U vs 0(0,4) U, P=0.003]. There were no statistically significant differences in operative mortality, intraoperative and postoperative intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) use, re-operation rate, perioperative major adverse cardiac and cerebrovascular events (MACCE), new-onset renal failure, atrial fibrillation, and multiple organ failure between the two groups. Postoperative angiography showed that there was no significant difference in the patency rate between the MICS-TACR group and control group(all P>0.05). Conclusion Total arterial coronary revascularization can be successfully accomplished under the left anterior small incision, and the early clinical outcome is satisfied.
作者
宫一宸
凌云鹏
吴松
崔仲奇
赵鸿
张鲁锋
宋之明
傅元豪
杨航
Gong Yichen;Ling Yunpeng;Wu Song;Cui Zhongqi;Zhao Hong;Zhang Lufeng;Song Zhiming;FuYuanhao;Yang Hang(Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第14期1063-1068,共6页
National Medical Journal of China
关键词
外科手术
微创性
冠状动脉旁路移植术
全动脉化血运重建
冠状血管造影术
Surgical procedures, minimally invasive
Coronary artery bypass
Total arterial revascularization
Coronary angiography
