Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach
Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach
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DOI：
10.1016/s1010-7940(99)00004-4
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发表时间：
1999-05-01
影响因子：
3.4
通讯作者：
Mohr, FW
中科院分区：
文献类型：
--
作者：
Diegeler, A;Matin, M;Mohr, FW
目的：本研究的目的是评价微创冠状动脉旁路移植术后早期和中期的血管造影结果。方法：271例微创直接冠状动脉搭桥术(MIDCAB)患者中221例(81.5%)于术后第2~6天(POD)行常规冠状动脉造影术，评价胸内动脉(ITA)及其吻合口的质量。6个月后，130例(47.9%)患者再次行血管造影。结果：术后早期通畅率为96.8%。吻合口中度狭窄50%~75%13例(5.8%)，重度狭窄75%以上10例(4.5%)，移植物闭塞3例(1.3%)。对严重狭窄的患者进行负荷心电监测，以引起ST段改变或临床表现为心肌缺血。221例患者中有3例(1.8%)负荷试验阳性。7/221(3.1%)患者需要早期再干预。术后6个月血管造影复查通畅率为95.4%。130例患者中，5例(3.8%)出现中度吻合口狭窄，3例(2.0%)出现重度狭窄，1例(0.7%)在负荷试验中出现心肌缺血。移植物闭塞3/130例(2.3%)。在随访期间，4/130(3.0%)患者接受了再次干预。术后早期和术后6个月的血管造影结果显示，4/15例患者(26.6%)狭窄程度减轻或消失。结论：微创不停跳心脏搭桥术后可能发生吻合口狭窄，术后应进行血管造影，以提供质量控制，指导进一步治疗。后者是必要的，如果狭窄伴随着减少的血流量和负荷试验期间心肌缺血的证据。吻合口早期狭窄的改善有望超过25%。(C)1999 Elsevier Science B.V.保留所有权利。
Objective: The aim of the study was to evaluate the early and mid-term angiographic results after minimally invasive coronary bypass grafting using an 'off-pump' technique via a lateral minithoracotomy. Methods: In 221 out of 271 patients (81.5%) who underwent minimally invasive direct coronary bypass grafting (MIDCAB) the quality of the internal thoracic artery (ITA)-graft and the anastomosis was evaluated by conventional coronary angiography between the 2nd and 6th postoperative day (POD). A subgroup of 130 patients (47.9%) of the initial cohort were repeatedly controlled by angiography 6 months later, Results: The early postoperatively patency rate of the grafts was (96.8%). Moderate anastomotic stenosis between 50 and 75% was found in 13/221 (5.8%) patients, whereas severe stenosis of more than 75% was seen in 10/221 (4.5%) and occlusion of the graft in 3/221 (1.3%) patients. A stress-ECG was performed in patients with a severe stenosis to provoke ST-segment changes or clinical findings of myocardial ischemia. A positive stress test was found in 3/221 patients (1,8%). Early re-intervention was required in 7/221 (3.1%) patients. After 6 months, angiographic follow-up revealed a patency rate of (95.4%). Of 130 patients 5 (3.8%) presented with moderate anastomotic stenosis, whereas 3/130 (2.0%) patients showed a severe stenosis with one patient (0.7%) having myocardial ischemia during stress test. Occlusion of the graft was seen in 3/130 patients (2.3%). During follow-up, 4/130 (3.0%) patients underwent re-intervention. A comparison between early postoperative and 6-months angiogram revealed a decrease or a disappearance of the severity of the stenosis in 4/15 patients (26.6%). Conclusion: Since stenosis of the anastomosis may occur after minimally invasive, beating heart coronary bypass grafting, postoperative angiography should be performed to provide quality control and to guide appropriate further treatment. The latter is necessary if the stenosis is accompanied by reduced runoff and evidence of myocardial ischemia during stress test. An improvement of early stenosis at the anastomosis may be expected in more than 25%. (C) 1999 Elsevier Science B.V. All rights reserved.