Tarelli G, Mantovani V, Maugeri R, Chelazzi P, Vanoli D, Grossi C, Ornaghi D, Panisi P, Sala A
Department of Cardiac Surgery, Centro A. De Gasperis, Hospital Niguarda Ca' Granda, Milan, Italy.
Ital Heart J. 2001 Jun;2(6):423-7.
In view of the superior patency of the internal mammary artery (IMA), grafting of this vessel to the left anterior descending artery is advantageous in terms of survival and quality of life; the benefits of using both the mammary arteries remain unproved.
Among the patients operated upon during the period 1988-1990, we randomly selected 150 patients in whom one IMA (group 1) was grafted and 150 patients in whom both IMAs (group 2) were grafted. The survival and event free curves of these two groups of patients were designed using the Kaplan-Mayer method; the log-rank test was used to assess the statistical difference between the curves and to determine whether, in the long term, benefits were superior in patients in whom both IMAs were grafted.
Patients in group 1 were older (p = 0.002). In this group there were more patients with diabetes (p = 0.004) and with peripheral vascular disease (p = 0.047). There were more female patients in group 2 (p < 0.02) and more coronary vessels were grafted (p = 0.03). Follow-up was complete (100%) and equivalent in duration for both groups (109 +/- 30 months for group 1 and 110 +/- 33 months for group 2, p = NS). The survival rate at 10 years was equal for both groups (82.5 +/- 3.4% for group 2 vs 82.9 +/- 3.2% for group 1, p = NS) and so was the freedom from cardiac death. The provocative test for myocardial ischemia was more frequently positive in group 1 than in group 2 (21 vs 10 cases, p = 0.054). Freedom from new myocardial infarction (p = NS), angina recurrence (p = NS) and reoperation (p = NS) was equally distributed during follow-up. Group 2 patients more frequently necessitated coronary angioplasty but the difference was not significant (p = 0.17). Survival free from angina recurrence, new myocardial infarction, coronary angioplasty and reoperation was more frequent in group 2 (respectively 74.6 +/- 3.8 vs 70.7 +/- 4.1%) but the difference was not statistically significant (p = NS).
After 12 years of follow-up, patients submitted to grafting of a single IMA more frequently presented with inducible myocardial ischemia, but neither survival nor the quality of life were superior in the patients in whom both IMAs were grafted.
鉴于乳内动脉（IMA）具有更好的通畅性，将该血管移植至左前降支动脉在生存和生活质量方面具有优势；使用双侧乳内动脉的益处尚未得到证实。
在1988 - 1990年期间接受手术的患者中，我们随机选择了150例接受单侧IMA移植的患者（第1组）和150例接受双侧IMA移植的患者（第2组）。采用Kaplan - Mayer方法绘制这两组患者的生存曲线和无事件曲线；使用对数秩检验评估曲线之间的统计学差异，并确定从长期来看，双侧IMA移植患者的获益是否更优。
第1组患者年龄更大（p = 0.002）。该组中糖尿病患者（p = 0.004）和外周血管疾病患者（p = 0.047）更多。第2组女性患者更多（p < 0.02），且移植的冠状动脉血管更多（p = 0.03）。随访完整（100%），两组随访时间相当（第1组为109 ± 30个月，第2组为110 ± 33个月，p = 无显著性差异）。两组10年生存率相等（第2组为82.5 ± 3.4%，第1组为82.9 ± 3.2%，p = 无显著性差异），心源性死亡的自由度也相等。第1组心肌缺血激发试验阳性的频率高于第2组（21例对10例，p = 0.054）。随访期间，新发心肌梗死（p = 无显著性差异）、心绞痛复发（p = 无显著性差异）和再次手术（p = 无显著性差异）的自由度分布相同。第2组患者更常需要进行冠状动脉血管成形术，但差异不显著（p = 0.17）。第2组无心绞痛复发、新发心肌梗死、冠状动脉血管成形术和再次手术的生存率更高（分别为74.6 ± 3.8%对70.7 ± 4.1%），但差异无统计学意义（p = 无显著性差异）。
经过12年的随访，接受单侧IMA移植的患者更常出现可诱导的心肌缺血，但双侧IMA移植患者的生存率和生活质量均未更优。
