Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts.
Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts.
复制标题
非体外循环冠状动脉搭桥术中的双侧骨架化胸廓内动脉移植：Y 与原位移植的早期结果。
DOI：
10.1016/s0003-4975(02)03974-7
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发表时间：
2002
影响因子：
4.6
通讯作者：
Yong Lak Kim
中科院分区：
文献类型：
--
作者：
Ki;Kwang Ree Cho;Woo;C. Lim;B. Ham;Yong Lak Kim
背景在非体外循环冠状动脉旁路移植术（OPCAB）中使用双侧钙化胸廓内动脉（ITAs）保留了一些优点，最终可能会导致更好的患者结局。我们比较了使用双侧ITAs作为Y型移植物的OPCAB的早期结果与使用双侧ITAs作为原位移植物的OPCAB的结果。I组（n = 113）或原位移植（第二组，结果I组每例患者的远端骨缺损数和每例双侧ITA的远端骨缺损数均高于I组，（3.5 ± 1.0）和（2.9 ± 0.7）比II组（3.0 ± 0.7和2.4 ± 0.5）（p < 0.01）。组I和组II的住院死亡率分别为1.8%（2/113）和0.9%（1/110）（p = ns）。组I和组II的术后并发症无差异，包括房颤（13.3% vs 10.9%）、围手术期心肌梗死（0.9% vs 2.7%）、纵隔炎（0.9% vs 1.8%）和低灌注综合征（0.9% vs 0%）（p = ns）。I组110例患者和II组108例患者的术后冠状动脉造影显示，I组使用ITA的总体通畅率为99.0%（382/386），远端闭塞通畅率为99.4%（319/321），II组总通畅率为98.1%（312/318），远端闭塞率为98.1%（258/263）。有两组之间的移植物通畅率无显着差异（p = ns）。ConclusionsOur结果表明，OPCAB使用双边tumonized ITA在技术上是可行的，具有良好的移植物通畅性。使用双侧钙化ITA作为Y型移植物增加了可进行的远端钙化的数量，并且不会导致额外的术后发病率。
BackgroundUse of bilateral skeletonized internal thoracic arteries (ITAs) in off-pump coronary artery bypass (OPCAB) retains several advantages that may eventually result in better patient outcomes. We compared the early results of OPCAB using bilateral ITAs as Y grafts with results of OPCAB using bilateral ITAs as in situ grafts.MethodsA total of 223 consecutive patients who underwent OPCAB using bilateral skeletonized ITAs as Y grafts (group I, n = 113) or in situ grafts (group II, n = 110) were studied.ResultsBoth the number of distal anastomoses per patient and the number of distal anastomoses per bilateral ITA were higher in group I (3.5 ± 1.0 and 2.9 ± 0.7) than in group II (3.0 ± 0.7 and 2.4 ± 0.5) (p < 0.01). Hospital mortality was 1.8% (2/113) in group I and 0.9% (1/110) in group II (p = ns). There were no differences in postoperative complications including atrial fibrillation (13.3% vs 10.9%), perioperative myocardial infarction (0.9% vs 2.7%), mediastinitis (0.9% vs 1.8%), and hypoperfusion syndrome (0.9% vs 0%) between groups I and II (p = ns). Postoperative coronary angiographies performed in 110 patients in group I and 108 patients in group II showed 99.0% (382/386) overall patency and 99.4% (319/321) patency for distal anastomoses using ITAs in group I, and 98.1% (312/318) overall patency and 98.1% (258/263) patency for distal anastomoses using ITA in group II. There were no significant differences in graft patency rates between the two groups (p = ns).ConclusionsOur results demonstrate that OPCAB using bilateral skeletonized ITAs is technically feasible, with excellent graft patency. Using bilateral skeletonized ITAs as Y grafts increases the number of distal anastomoses that can be performed and does not cause additional postoperative morbidity.