Clinical outcome, pain perception and activities of daily life after minimally invasive coronary artery bypass grafting
Clinical outcome, pain perception and activities of daily life after minimally invasive coronary artery bypass grafting
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DOI：
10.5152/akd.2014.4570
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发表时间：
2014-03-01
影响因子：
1.3
通讯作者：
Aybek, Tayfun
中科院分区：
文献类型：
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作者：
Uymaz, Baris;Sezer, Gul;Aybek, Tayfun
目的：微创直接冠状动脉搭桥术(MIDCAB)左前降支血运重建已成为常规手术。方法：回顾分析经胸骨下段部分切开行心内直视下心脏不停跳的MIDCAB手术的临床经验，并与传统的全胸骨切开手术的疼痛感觉、日常生活活动能力(ADL)进行回顾性比较。方法：自2009年1月至2012年8月，对197例MIDCAB患者采用改良下胸骨切开术。平均年龄58.5岁。方法：从2009年1月至2012年8月，197例患者接受了改良的偏最小二乘法多腔冠状动脉搭桥术。平均年龄为585岁+/-10.5岁。54例(28%)有心肌梗死史，38例(19%)有糖尿病史。术后4d内进行疼痛1、2、3级视觉模拟评分(VAS)和活动功能ADL评分。98%的患者接受了直接访问和问卷调查，以评估主要不良心脏事件(MACE)。结果：术后死亡1例(0.5%)，中转胸骨3例(1.5%)。术后血管造影34例(17.2%)，随访45个月有症状。移植血管通畅率为96.5%(190/197)。术后随访(24.1+/-11.7个月)，3.5年无MACE生存率为91.8+/-3.1%。术后视觉模拟评分(VAS 35.1+/-9.6 vs.57.1+/-7.8)和ADL评分(80.4+/-11.8 vs.36.2+/-8.6)均显著高于胸骨全切开心脏不停跳血运重建术对照组(p
Objective: Minimally invasive direct coronary artery bypass (MIDCAB) for revascularization of the left anterior descending artery has become a routine operation. We present our clinical experiences with beating heart MIDCAB surgery performed through partial lower sternotomy (PLS) and retrospectively compare the results of pain perception as well as activities of daily life (ADL) with the conventional full sternotomy.Methods: From January 2009 to August 2012, 197 patients underwent MIDCAB using modified PLS at our hospital. Their mean age was 58.5Methods: From January 2009 to August 2012, 197 patients underwent MIDCAB using modified PLS at our hospital. Their mean age was 585 +/- 10.5 years. 54 (28%) had previous myocardial infarction, 38 (19%) had diabetes mellitus. The visual analog scale (VAS) for pain one, two and three, the ADL score for mobilization were obtained within four days after surgery. 98% of patients were followed-up with both direct visits and questionnaires to assess the major adverse cardiac events (MACE). We performed t-test for comperative data and Kaplan-Meier curves for survival analysis.Results: There was one postoperative death (0.5%) and three conversions to full sternotomy (1.5%). Postoperative angiography was performed in 34 (17.2%) patients, who had some symptoms during the follow-up period of 45 months. The graft patency rate was 96.5% (190 of 197). At follow-up (24.1 +/- 11.7 months), survival free of MACE was 91.8 +/- 3.1% at 3.5 years. Both the Visual Analog Scale (VAS 35.1 +/- 9.6 vs. 57.1 +/- 7.8) and the ADL score (80.4 +/- 11.8 vs. 36.2 +/- 8.6) were significantly higher after the operation in comparison to the matched group of beating heart revascularizations with full sternotomy (p