Lai Yongqiang, Huang Fangjiong, Yang Jinfei, Xu Chunlei, Wu Qiang
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2002 Nov 10;82(21):1454-6.
To evaluate the effects of application of bilateral internal mammary artery grafts in coronary artery by pass grafting (CABG).
From Jan. 1998 to Mar. 2001, 51 patients with coronary arteriosclerotic cardiopathy, all males, aged 36 - 65 (average 49.9 years), underwent coronary artery bypass grafting with bilateral internal mammary artery grafts. The pathologic change involved three branches of coronary artery in 48 cases and involved the left main trunk in 3 cases. 37 patients had the history of myocardial infarction. Four cases were complicated by left ventricular aneurysm. 47 cases were operated upon on-pump and 4 off-pump. Left ventricular aneurysmectomy was done in 4 patients and coronary endarterectomy in 1 patient. The patterns of anastomosis were as follows: right internal mammary artery (RIMA) to left anterior descending artery (LAD) and left internal mammary artery (LIMA) to obtuse marginal (OM) in 39 cases, LIMA to LAD and RIMA to right coronary artery (RCA) in 9 cases, and LIMA to LAD and RIMA to OM in 3 cases. Gastroepiploic artery and left radical artery were used in other bypass grafting. The average number of grafts used for each case was 3.
There were 3 early operative deaths, with an early operative mortality rate of 5.9%. One patient died of low output syndrome due to perioperative myocardial infection, 1 patient died of refractory arrhythmia, and 1 patient died of cerebral accident 40 days after operation. Intraaortic balloon pump was used in 4 cases post-operatively. Mediastinal infection occurred in 2 patients. The patients were followed up for 2 to 39 months (average 15.5 months). During the follow-up, no angina pectoris occurred and ultrasonography showed that the bilateral internal mammary artery grafts were unobstructed in all patients.
Bilateral internal mammary artery grafts can be applied effectively in CABG with a good short-term effect, especially for young patients.
评估双侧乳内动脉移植在冠状动脉旁路移植术（CABG）中的应用效果。
1998年1月至2001年3月，51例男性冠状动脉粥样硬化性心脏病患者，年龄36 - 65岁（平均49.9岁），接受了双侧乳内动脉冠状动脉旁路移植术。48例患者的病变累及冠状动脉的三个分支，3例累及左主干。37例患者有心肌梗死病史。4例合并左心室室壁瘤。47例在体外循环下手术，4例在非体外循环下手术。4例患者行左心室室壁瘤切除术，1例患者行冠状动脉内膜切除术。吻合方式如下：39例为右乳内动脉（RIMA）至左前降支（LAD），左乳内动脉（LIMA）至钝缘支（OM）；9例为LIMA至LAD，RIMA至右冠状动脉（RCA）；3例为LIMA至LAD，RIMA至OM。其他旁路移植使用胃网膜动脉和左桡动脉。每例患者平均使用的移植血管数为3根。
早期手术死亡3例，早期手术死亡率为5.9%。1例患者因围手术期心肌感染死于低心排综合征，1例患者死于难治性心律失常，1例患者术后40天死于脑意外。4例患者术后使用了主动脉内球囊反搏。2例患者发生纵隔感染。患者随访2至39个月（平均15.5个月）。随访期间，所有患者均未发生心绞痛，超声检查显示双侧乳内动脉移植血管通畅。
双侧乳内动脉移植可有效应用于冠状动脉旁路移植术，近期效果良好，尤其适用于年轻患者。
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