Free internal mammary artery graft in myocardial revascularization.
Free internal mammary artery graft in myocardial revascularization.
复制标题
DOI：
10.1016/0967-2109(96)82318-0
复制
发表时间：
1996-04-01
期刊：
影响因子：
--
通讯作者：
Dion, R
中科院分区：
文献类型：
--
作者：
Verhelst, R;Etienne, P Y;Dion, R
1986年8月至1993年3月，124例患者（102例男性;平均年龄59岁）接受了至少一条游离乳内动脉（FIMA）的心肌血运重建术。这一组占同期进行的2725例冠状动脉搭桥术的4.5%。76例患者（61%）至少有一次心肌梗死病史。45例患者（36%）有不稳定型心绞痛，100例（80.5%）有三支血管病变，22例（17.7%）左室射血分数低于0.4。18例（14.5%）再次手术，90例（72.5%）双侧乳内动脉（IMA）移植。使用FIMA的原因是：83例患者的乳内动脉蒂太短，30例患者在采集时IMA损伤，11例患者带蒂IMA（PIMA）移植区域的旁路术后缺血。所有病例均采用体外循环、中度低温（30 ℃）和晶体顺逆停搏液。67个FIMA移植物直接缝合到升主动脉; 57个使用聚丙烯7/0连续缝线通过隐兜帽缝合，3个端对端缝合到PIMA移植物。FIMA移植物定向于左前降支（34%）、回旋支（37%）和右冠状动脉（29%）。总共使用127个FIMA、136个PIMA和158个隐静脉构建了179个球囊（每例患者3.8个球囊）。住院死亡率和术后心肌梗死率分别为5.6%（7例患者）和3.2%（4例患者）。心脏相关死亡率为3.2%（4例患者）;这4例患者中有3例因进展性梗死接受了手术，1例接受了再次手术。117名幸存者中有4人后来死亡;其中2人与心脏有关，是9个月和12个月时全球心力衰竭的结果。在剩余的113例患者中，106例在平均随访28.2（范围3-84）个月后无症状。59例患者（50.4%）在平均15个月的时间间隔进行了血管造影再研究。FIMA直接或经大隐静脉引流的通畅率分别为82.8%和89.7%。前降支、回旋支和右冠状动脉的通畅率分别为85.7%、88%和83.3%。全球FIMA通畅率为86.4%，而全球PIMA通畅率为100%。与PIMA相比，FIMA的中期通畅率较差：因此，FIMA应仅限于PIMA或其他带蒂动脉移植物不可用的病例。
Between August 1986 and March 1993, 124 patients (102 men; mean age of 59 years) underwent myocardial revascularization with the use of at least one free internal mammary artery (FIMA). This group represents 4.5% of the 2725 coronary bypasses performed during the same period. Seventy-six patients (61%) had suffered from at least one previous myocardial infarction. Forty-five patients (36%) had unstable angina; three-vessel disease was found in 100 cases (80.5%) and a left ventricular ejection fraction lower than 0.4 in 22 (17.7%). There were 18 (14.5%) redo procedures and 90 (72.5%) bilateral internal mammary artery (IMA) grafts. The reasons for using a FIMA were: too short an internal mammary artery pedicle in 83 patients, IMA injury at harvesting in 30 patients and post-bypass ischaemia in areas grafted with pedicled IMA (PIMA) in 11 patients. Cardiopulmonary bypass, moderate hypothermia (30 degrees C) and crystalloid anterograde and retrograde cardioplegia were used in all cases. Sixty-seven FIMA grafts were anastomosed directly to the ascending aorta; 57 were sutured via a saphenous hood using a running suture of polypropylene 7/0 and three were anastomosed end-to-end to a PIMA graft. FIMA grafts were directed to the left anterior descending (34%), the circumflex (37%) and the right coronary artery (29%). In total, 179 anastomoses were constructed using 127 FIMA, 136 using PIMA and 158 using saphenous veins (3.8 anastomoses per patient). Hospital mortality and postoperative myocardial infarction rates were 5.6% (seven patients) and 3.2% (four patients), respectively. Cardiac-related mortality was 3.2% (four patients); three of these four patients had been operated on for evolving infarction and one underwent a redo procedure. Four of the 117 survivors died later on; in two, it was cardiac-related and a result of global heart failure at 9 and 12 months. Of the 113 remaining patients, 106 are symptom free after a mean follow-up of 28.2 (range 3-84) months. Fifty-nine patients (50.4%) were restudied by angiography at a mean interval of 15 months. Patency rates of FIMA anastomosed either directly to the aorta or via a saphenous hood were 82.8 or 89.7%, respectively. Patency rates of FIMA directed to the left anterior descending, the circumflex and the right coronary artery were 85.7, 88 and 83.3%, respectively. Global FIMA patency was 86.4%, while global PIMA patency was 100%. The FIMA mid-term patency rates compare unfavourably with those of PIMA: FIMA should therefore be restricted to the cases where PIMA or other pedicled arterial grafts are unavailable.