Bartnes Kristian, Vonen Barthold, Tofte Arne Johannes, Gunnes Pål, Lunde Per, Myrmel Truls, Sørlie Dag, Lie Mons
Universitetssykehuset Nord-Norge 9038 Tromsø.
Tidsskr Nor Laegeforen. 2002 Feb 28;122(6):594-8.
From 1986 we have routinely used the left internal mammary artery instead of autologous vein as bypass to the left anterior descending coronary artery.
A cohort of 52 patients has been followed up for up to 12 years. Six years postoperatively, 40 patients were evaluated by clinical examination, exercise testing and serum lipid assessment. Of these, 38 underwent angiography of the native coronary arteries and of all grafts, which represented 47 left internal mammary artery, 90 saphenous vein, and 3 right internal mammary artery bypasses. Information regarding angina recurrence and the need for repeated revascularisation was obtained from hospital records. Twelve-year mortality data were provided by public registers.
Fifty patients were discharged alive. Two serious complications, of which one was fatal, were directly related to the use of the left internal mammary artery. After six years, all the re-examined patients had improved their exercise tolerance; 25 (63%) were angina-free. 44 (94%) left internal mammary artery and 67 (74%) saphenous vein bypasses were patent. Tobacco consumption was considerably reduced over the first six years postoperatively while mean triglyceride and cholesterol levels remained moderately elevated. After 12 years, 18 patients were deceased, half of them from coronary heart disease.
Our results are in accordance with large, international studies.
自1986年起，我们常规使用左乳内动脉而非自体静脉作为左前降支冠状动脉的旁路移植血管。
对52例患者进行了长达12年的随访。术后6年时，通过临床检查、运动试验和血脂评估对40例患者进行了评估。其中，38例患者接受了冠状动脉造影，包括所有移植血管，共47条左乳内动脉、90条大隐静脉和3条右乳内动脉旁路移植血管。从医院记录中获取有关心绞痛复发和再次血运重建需求的信息。12年死亡率数据由公共登记处提供。
50例患者存活出院。有2例严重并发症，其中1例致命，均与左乳内动脉的使用直接相关。6年后，所有接受复查的患者运动耐量均有所改善；25例（63%）患者无心绞痛。44条（94%）左乳内动脉和67条（74%）大隐静脉旁路移植血管通畅。术后头6年吸烟量大幅减少，而甘油三酯和胆固醇平均水平仍中度升高。12年后，18例患者死亡，其中一半死于冠心病。
我们的结果与大型国际研究一致。
