Zenati M, Cohen H A, Griffith B P
Divisions of Cardiothoracic Surgery and Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Thorac Cardiovasc Surg. 1999 Mar;117(3):439-44; discussion 444-6. doi: 10.1016/s0022-5223(99)70322-3.
Integrated coronary revascularization combines minimally invasive coronary artery bypass grafting (MICABG) with left internal thoracic artery-left anterior descending artery grafting and percutaneous coronary intervention. We hypothesized that integrated coronary revascularization could result in successful revascularization in suitable patients with multivessel coronary artery disease.
Between September 1996 and January 1998, 31 consecutive patients underwent integrated coronary revascularization. Twenty-two were male; mean age was 69 years (46-86 years) and 42% were older than 75 years. Eight patients (26%) had a Parsonnet score greater than 20%. Left ventricular ejection fraction was 46.3% +/- 12%; 6 patients (19%) had a left ventricular ejection fraction less than 35%.
The anastomosis time for MICABG with the internal thoracic artery was 14.6 +/- 5.2 minutes and the operating time was 105 +/- 20 minutes; 28 patients (90%) were extubated in the operating room. The internal thoracic artery anastomosis was patent in all 31 patients (100%). Percutaneous coronary intervention was performed before MICABG in 2 patients (7%), on the same day of MICABG in 16 patients (52%), on postoperative day 1 in 3 patients (9%), and on postoperative days 2 to 4 in 10 patients (32%). Postprocedure length of stay in the hospital was 2.7 +/- 1.0 days and 13 patients (42%) were discharged home on postoperative day 1 or 2. Three patients (9.6%) required repeat target vessel revascularization in the distribution of the previous percutaneous coronary intervention. All patients are alive without angina at a follow-up of 10.8 +/- 3.8 months.
Our early results demonstrate that integrated coronary revascularization can be performed safely and effectively. Long-term results will be available from a prospective randomized trial now underway to compare integrated coronary revascularization with coronary artery bypass grafting for multivessel coronary artery disease.
综合性冠状动脉血运重建术是将微创冠状动脉旁路移植术（MICABG）与左胸廓内动脉-左前降支动脉移植术及经皮冠状动脉介入治疗相结合。我们假设综合性冠状动脉血运重建术能使合适的多支冠状动脉疾病患者成功实现血运重建。
在1996年9月至1998年1月期间，31例连续患者接受了综合性冠状动脉血运重建术。其中22例为男性；平均年龄69岁（46 - 86岁），42%的患者年龄超过75岁。8例患者（26%）的Parsonnet评分大于20%。左心室射血分数为46.3%±12%；6例患者（19%）的左心室射血分数小于35%。
MICABG与胸廓内动脉的吻合时间为14.6±5.2分钟，手术时间为105±20分钟；28例患者（90%）在手术室拔管。31例患者（100%）的胸廓内动脉吻合均通畅。2例患者（7%）在MICABG前进行了经皮冠状动脉介入治疗，16例患者（52%）在MICABG同一天进行了该治疗，3例患者（9%）在术后第1天进行，10例患者（32%）在术后第2至4天进行。术后住院时间为2.7±1.0天，13例患者（42%）在术后第1天或第2天出院回家。3例患者（9.6%）需要对先前经皮冠状动脉介入治疗的靶血管分布区域进行再次血运重建。在10.8±3.8个月的随访中，所有患者均存活且无心绞痛症状。
我们的早期结果表明，综合性冠状动脉血运重建术可以安全有效地实施。目前正在进行一项前瞻性随机试验，以比较综合性冠状动脉血运重建术与多支冠状动脉疾病的冠状动脉旁路移植术，届时将得出长期结果。
