Stamou S C, Bafi A S, Boyce S W, Pfister A J, Dullum M K, Hill P C, Zaki S, Garcia J M, Corso P J
Department of Surgery, Washington Hospital Center, and MedStar Research Institute, Washington, DC 20010, USA.
Ann Thorac Surg. 2000 Oct;70(4):1371-7. doi: 10.1016/s0003-4975(00)01680-5.
Minimally invasive direct coronary artery bypass, without cardiopulmonary bypass, through a left lateral thoracotomy approach (lateral MIDCAB), is a safe alternative to coronary artery bypass surgery using cardiopulmonary bypass (on-pump CABG) of the circumflex system via median sternotomy. However, it is unknown whether lateral MIDCAB may yield an improved long-term outcome over the conventional on-pump median sternotomy approach.
We compared the perioperative outcomes of patients undergoing lateral MIDCAB (n = 34) versus conventional on-pump CABG of the circumflex system (n = 16) from June 1996 to July 1999. The two groups were similar with respect to baseline characteristics and risk stratification. Patients who required only one or two grafts for complete revascularization were included.
Lateral MIDCAB patients had a lower need than on-pump CABG patients for intraoperative (12% MIDCAB vs 43% on-pump CABG, p = 0.03) and postoperative transfusions (29% vs 69%, p = 0.01), had fewer neuropsychologic changes (0% vs 19%, p = 0.03), and had a lower rate of postoperative atrial fibrillation (12% vs 44%, p = 0.02). Lateral MIDCAB was also associated with a significantly lower postoperative length of stay (5 +/- 2 vs 7 +/- 3 days, p = 0.02). Actuarial survival at a mean period of follow-up of 19 +/- 11 months was 97% for the lateral MIDCAB versus 88% for the on-pump CABG group (p = 0.6). Event-free survival was 88% for lateral MIDCAB versus 81% for on-pump CABG (p = 0.1).
Lateral MIDCAB may safely be performed in patients with isolated coronary artery disease of the circumflex system with improved early morbidity and an abbreviated hospital stay compared with conventional median sternotomy on-pump CABG.
通过左外侧胸廓切开术入路（外侧微创直接冠状动脉搭桥术，lateral MIDCAB）进行的非体外循环微创直接冠状动脉搭桥术，是经正中胸骨切开术进行体外循环冠状动脉搭桥术（体外循环冠状动脉搭桥术，on-pump CABG）治疗回旋支系统疾病的一种安全替代方法。然而，外侧MIDCAB与传统的体外循环正中胸骨切开术相比，长期疗效是否更好尚不清楚。
我们比较了1996年6月至1999年7月期间接受外侧MIDCAB（n = 34）与传统体外循环冠状动脉搭桥术治疗回旋支系统疾病（n = 16）患者的围手术期结果。两组在基线特征和风险分层方面相似。纳入仅需一或两支移植血管进行完全血运重建的患者。
外侧MIDCAB患者术中输血需求低于体外循环冠状动脉搭桥术患者（12%的外侧MIDCAB患者 vs 43%的体外循环冠状动脉搭桥术患者，p = 0.03），术后输血需求也更低（29% vs 69%，p = 0.01），神经心理变化更少（0% vs 19%，p = 0.03），术后房颤发生率更低（12% vs 44%，p = 0.02）。外侧MIDCAB术后住院时间也显著缩短（5±2天 vs 7±3天，p = 0.02）。在平均19±11个月的随访期，外侧MIDCAB组的精算生存率为97%，体外循环冠状动脉搭桥术组为88%（p = 0.6）。无事件生存率外侧MIDCAB组为88%，体外循环冠状动脉搭桥术组为81%（p = 0.1）。
对于孤立性回旋支系统冠状动脉疾病患者，与传统正中胸骨切开术体外循环冠状动脉搭桥术相比，外侧MIDCAB可安全实施，且早期发病率更低，住院时间更短。
