Diegeler A, Spyrantis N, Matin M, Falk V, Hambrecht R, Autschbach R, Mohr F W, Schuler G
Department of Cardiac Surgery, Universität Leipzig, Heartcenter, Russenstrasse 19, 04289, Leipzig, Germany.
Eur J Cardiothorac Surg. 2000 May;17(5):501-4. doi: 10.1016/s1010-7940(00)00400-0.
Percutaneous coronary angioplasty (PTCA) and stent implantation have become the first-line intervention for patients with isolated proximal LAD-lesions. Minimally invasive direct coronary artery bypass surgery (MIDCAB) has recently been developed to reduce surgical invasiveness for single LAD revascularization. This study focus on the question whether MIDCAB could be an alternative treatment for isolated proximal LAD lesions.
Starting in 1996, MIDCAB was performed in 618 patients. Angiography was performed before discharge and repeated after 6 months at follow-up examination. In an ongoing randomized trial 150 patients with an indication for treatment of a LAD lesion have been included to compare the mid-term outcome after PTCA (n=79) vs. MIDCAB (n=71).
In 618 MIDCAB procedures 30-day mortality was 0.6%, perioperative myocardial infarction rate was 1.6%. The conversion rate to sternotomy was 3.4%. The learning curve was demonstrated by a patency rate of 96.0% in 1997, 98.0% in 1998 and 99.1% in 1999, respectively. At 6 months patency rate was 94.4% in 1997 and 97.0% in 1998. The rate of severe stenosis >75% dropped from 5.4% in 1997 to 3.4% in 1998. The over all rate of reinterventions was 5.6%. The preliminary result of the randomized trial revealed a difference in the number of perioperative adverse events, 11.4% in the MIDCAB group vs. 6.3% in the PTCA group (P<0.05). At 6 months follow-up 88. 7% of the MIDCAB patients were free from angina vs. 58.2% of the PTCA patients (P<0.02). Restenosis and a positive stress test was diagnosed in 27.9% of the PTCA patients vs. 8.4% of the MIDCAB patients (P<0.02). Reintervention was necessary in 27.9% of the patients after PTCA vs. 8.4% of the patients after MIDCAB.
MIDCAB is a safe and effective but technically demanding procedure. Perioperative adverse events may be expected, but early as well as mid-term patency rate are good. When compared to PTCA, the freedom from angina and the need for additional revascularization procedures after 6 months is statistically better for patients having MIDCAB surgery. Thus, MIDCAB is considered a valuable alternative for isolated proximal high grade LAD lesions.
经皮冠状动脉腔内血管成形术（PTCA）及支架植入术已成为孤立性左前降支近端病变患者的一线干预措施。近年来，为降低单支左前降支血运重建的手术创伤，微创直接冠状动脉搭桥手术（MIDCAB）应运而生。本研究聚焦于MIDCAB能否作为孤立性左前降支近端病变的替代治疗方法这一问题。
自1996年起，对618例患者实施了MIDCAB手术。出院前进行血管造影，并在随访6个月时复查。在一项正在进行的随机试验中，纳入了150例有左前降支病变治疗指征的患者，以比较PTCA组（n = 79）与MIDCAB组（n = 71）的中期结果。
在618例MIDCAB手术中，30天死亡率为0.6%，围手术期心肌梗死发生率为1.6%。转为胸骨切开术的比例为3.4%。学习曲线表现为1997年通畅率为96.0%，1998年为98.0%，1999年为99.1%。6个月时，1997年通畅率为94.4%，1998年为97.0%。严重狭窄（>75%）发生率从1997年的5.4%降至1998年的3.4%。再次干预的总体发生率为5.6%。随机试验的初步结果显示，围手术期不良事件数量存在差异，MIDCAB组为11.4%，PTCA组为6.3%（P < 0.05）。随访至6个月时，MIDCAB组88.7%的患者无心绞痛，而PTCA组为58.2%（P < 0.02）。PTCA组27.9%的患者诊断为再狭窄及运动试验阳性，而MIDCAB组为8.4%（P < 0.02）。PTCA术后27.9%的患者需要再次干预，而MIDCAB术后为8.4%。
MIDCAB是一种安全有效的手术，但技术要求较高。围手术期可能会出现不良事件，但早期及中期通畅率良好。与PTCA相比，接受MIDCAB手术的患者在6个月后无心绞痛及再次血运重建需求方面在统计学上更具优势。因此，MIDCAB被认为是孤立性左前降支近端高度病变的一种有价值的替代治疗方法。
