Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery.
Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery.
复制标题
微创冠状动脉旁路移植术与冠状动脉成形术治疗左前降支孤立性 C 型狭窄。
DOI：
10.1016/s0022-5223(97)70191-0
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发表时间：
1997
影响因子：
6
通讯作者：
H. Crijns
中科院分区：
文献类型：
--
作者：
Massimo A Mariani;Piet W. Boonstra;J. Grandjean;Johannes O.J. Peels;Stefan H. J. Monnink;P. Heijer;H. Crijns
研究背景孤立性左前降支狭窄可以通过药物治疗、经皮冠状动脉腔内成形术或冠状动脉旁路移植术来治疗。最近开发了一种新的治疗方法，称为微创直接冠状动脉旁路移植术。方法对1995年1月至1996年7月181例单纯性左前降支C型狭窄患者行微创开胸手术和血管成形术进行比较。在这些患者中，71人接受了微创搭桥术，110人接受了血管成形术。结果两组患者的住院死亡率、围手术期心肌梗死、常规冠状动脉旁路移植术的急诊再手术、主动脉内球囊反搏的使用、脑血管意外发生率无显著差异。在1年随访时，两组患者的存活率无显著差异(微创搭桥术95.7%±0.2%vs血管成形术95.3%±0.2%p=0.89)，而微创搭桥组无重复血管重建的发生率显著高于微创搭桥组(搭桥术96.9%±0.2%vs血管成形术67.6%±0.5%；p<；0.001)。这项研究表明，在左前降支C型孤立狭窄的患者中，微创搭桥术比血管成形术对反复血运重建的需求显著减少，从而减少了医疗资源的使用。(胸心外科杂志1997；114：434-9)
BackgroundIsolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Recently a new treatment has been developed, which is called minimally invasive direct coronary artery bypass grafting. This new treatment is a modification of the conventional bypass operation and is performed through a small anterolateral thoracotomy without cardiopulmonary bypass.MethodsTo compare minimally invasive bypass with angioplasty, we evaluated in-hospital results and 1-year follow-up in 181 consecutive patients with isolated type C stenosis of the left anterior descending coronary artery between January 1995 and July 1996. Of these patients, 71 underwent minimally invasive bypass and 110 angioplasty. Preoperative characteristics were not significantly different between the two groups.ResultsIn-hospital death, periprocedural myocardial infarction, emergency reoperation by means of conventional coronary bypass grafting, useof an intraaortic balloon pump, and cerebrovascular accidents were not significantly different between the two groups. At 1-year follow-up, survivial was not significantly different in the two groups (minimally invasive bypass 95.7% ± 0.2% vs angioplasty 95.3% ± 0.2%p = 0.89), whereas freedom from repeated revascularization was significantly more common in the group undergoing minimally invasive bypass (bypass 96.9% ± 0.2% vs angioplasty 67.6% ± 0.5%;p < 0.001). This study shows that the need for repeated revascularization, and therefore the use of health care resources, is significantly less with minimally invasive bypass than with angioplasty in patients with isolated type C stenosis of the left anterior descending coronary artery. (J Thorac Cardiovasc Surg 1997;114:434-9)