Gall S, Lowe J E, Wolfe W G, Oldham H N, Van Trigt P, Glower D D
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Ann Thorac Surg. 2000 Feb;69(2):524-30. doi: 10.1016/s0003-4975(99)01399-5.
While internal mammary artery (IMA) use predicts improved survival after coronary bypass grafting (CABG), it remains unknown whether patients undergoing concomitant aortic valve replacement (AVR) realize a similar benefit.
All patients at a single teaching institution, undergoing combined AVR-CABG, which included a graft to the left anterior descending coronary artery (LAD) from 1984 to 1994 (n = 227) were examined retrospectively.
Patients receiving an IMA graft (yesIMA, n = 135) and patients receiving only saphenous vein grafts (nonIMA, n = 92) were not different in their presenting symptoms, or in their incidence of preoperative risk factors. The patients with IMA were more likely to be male, have a later year of operation, be younger, and have a greater body surface. Morbidity was not different between groups. IMA use did not affect 30-day mortality. Long-term actuarial survival was greater in the group with IMA (63% +/- 7% vs 42% +/- 6% at 5 years, p < 0.01). A multivariate Cox proportional hazards model demonstrated that use of an IMA graft improved survival, while recent myocardial infarction, diabetes, earlier year of operation, and lower ejection fraction diminished long-term survival. The relative risk of IMA grafting was 0.570.
Within the limits of a retrospective analysis, patients in a modern era of cardiac operation, who undergo combined AVR-CABG, do not suffer increased morbidity from IMA use, and may realize a survival benefit from use of the IMA as a conduit for bypass of the LAD coronary artery.
虽然使用乳内动脉（IMA）可预测冠状动脉旁路移植术（CABG）后生存率提高，但接受同期主动脉瓣置换术（AVR）的患者是否能获得类似益处仍不清楚。
对一家教学机构1984年至1994年期间接受AVR-CABG联合手术（包括移植至左前降支冠状动脉[LAD]）的所有患者（n = 227）进行回顾性研究。
接受IMA移植的患者（yesIMA，n = 135）和仅接受大隐静脉移植的患者（nonIMA，n = 92）在症状表现或术前危险因素发生率方面无差异。接受IMA移植的患者更可能为男性，手术年份较晚，年龄较小，体表面积较大。两组间发病率无差异。使用IMA不影响30天死亡率。IMA组的长期精算生存率更高（5年时为63%±7% vs 42%±6%，p < 0.01）。多变量Cox比例风险模型显示，使用IMA移植可提高生存率，而近期心肌梗死、糖尿病、手术年份较早和射血分数较低则会降低长期生存率。IMA移植的相对风险为0.570。
在回顾性分析的范围内，现代心脏手术时代接受AVR-CABG联合手术的患者不会因使用IMA而增加发病率，并且使用IMA作为LAD冠状动脉旁路移植的管道可能会获得生存益处。
