Midterm results after minimally invasive coronary surgery (last operation)
Midterm results after minimally invasive coronary surgery (last operation)
复制标题
DOI：
10.1016/s0022-5223(98)70353-8
复制
发表时间：
1998-04-01
影响因子：
6
通讯作者：
Vitolla, G
中科院分区：
文献类型：
--
作者：
Calafiore, AM;Di Giammarco, G;Vitolla, G
背景资料：我们回顾了经左前小切口将左胸廓内动脉移植到左前降支动脉的经验，以评估中期结果。研究方法：自1994年11月至1997年4月，460例患者计划接受左胸廓内动脉移植到左前降支冠状动脉，经左前小切口，这些患者中有26例（5.7%）转换，其中434人进行了手术。214例患者（49.3%）有左前降支的孤立性疾病，220例患者（50.7%）有多支血管疾病。采集足够长度的左胸廓内动脉，以到达左前降支动脉。结果：309例患者（71.2%）在2小时内拔管。重症监护室平均住院时间为4.2 ± 4.5小时;术后平均住院时间为66 ± 29小时; 30天死亡率为1.1%;晚期死亡率为1.4%。18名患者早期（小于或等于30天）接受了再次手术，8名患者因管道/吻合口故障而晚期（>30天）接受了再次手术。4例患者因疾病进展（n = 3）或心包炎（n = 1）再次手术，吻合口通畅。3例患者接受了经皮腔内冠状动脉成形术。累积血管造影和负荷多普勒血流评估结果，417例患者获得通畅吻合，404例患者获得非限制性吻合。术后29个月，生存率为97.1% ± 0.7%（95%置信区间为90.5%-100%），无事件生存率为89.4% ± 1.2%（95%置信区间为78.2%-100%）。在最后的190例患者中，随着我们经验的增加和更好的器械，我们在188例（98.9%）和185例（97.4%）中获得了通畅的吻合口和非限制性吻合口。结论：左前小切口开胸术的中期结果可接受。未闭性和非限制性肠梗阻的发生率是令人满意的，特别是在我们最近的经验中，当学习曲线结束时。
Background: Our experience with a left internal thoracic artery graft to the left anterior descending artery via a left anterior small thoracotomy is reviewed to evaluate midterm results. Methods: From November 1994 to April 1997, four hundred sixty patients were scheduled to undergo a left internal thoracic artery graft to the left anterior descending coronary artery via a left anterior small thoracotomy; 26 of these patients (5.7%) were converted and 434 of them had the operation. Two hundred fourteen patients (49.3%) had isolated disease of the left anterior descending artery, and 220 patients(50.7%) had multiple vessel disease. A sufficient length of the left internal thoracic artery was harvested to reach the left anterior descending artery. Results: Three hundred nine patients (71.2%) underwent extubation by hour 2. Mean intensive care unit stay was 4.2 +/- 4.5 hours; mean postoperative hospital stay was 66 +/- 29 hours; the 30-day mortality rate was 1.1%; the late mortality rate was 1.4%. Eighteen patients underwent reoperation early (less than or equal to 30 days), and eight patients underwent reoperation late (>30 days) because of conduit/anastomotic malfunction. Four patients underwent reoperation with patent anastomosis for progression of disease (n = 3) or pericarditis (n = 1). Three patients had a percutaneous transluminal coronary angioplasty. Cumulating angiographic and stress Doppler flow assessment results, a patent anastomosis was obtained in 417 patients and a nonrestrictive anastomosis in 404 patients. Twenty-nine months after surgery, survival was 97.1% +/- 0.7% (95% confidence interval 90.5% to 100%) and event-free survival 89.4% +/- 1.2% (95% confidence interval 78.2% to 100%). In the last 190 patients, with our increased experience and better instruments, we obtained a patent anastomosis in 188 patients (98.9%) and a nonrestrictive anastomosis in 185 (97.4%). Conclusions: Left anterior small thoracotomy gives acceptable midterm results. Incidence of patent and nonrestrictive anastomoses was satisfactory, especially in the most recent part of our experience, when the learning curve ended.