Gansera B, Angelis I, Botzenhardt F, Günzinger R, Neumaier-Prauser P, Kemkes B M
Krankenhaus München-Bogenhausen Abteilung für Kardiovaskularchirurgie Englschalkinger Str. 77 81925 München, Germany.
Z Kardiol. 2003 May;92(5):398-406. doi: 10.1007/s00392-003-0926-3.
CABG with bilateral IMA grafts (BIMA) can improve long-term results in cardiac morbidity and mortality. An enhanced incidence of bleeding and wound complications compared to patients with single IMA (SIMA) remains a matter of debate. The aim of the study was to compare the operative outcomes of patients who had undergone CABG with BIMA and SIMA in situ grafts, especially to identify patient-related risk factors, such as obesity, diabetes mellitus and age above 70 years.
Out of a total of 5144 patients operated on between January 1996 and September 1999, patients with isolated CABG (n = 3671) with BIMA or SIMA were analyzed retrospectively. In the BIMA group, the patients' (n = 1478) mean age was 64.0 years; mean EF was 62.1%. In the SIMA group (n = 2184), mean age was 65.4 years and mean EF was 60.6% (n.s.). In the BIMA group, the right IMA was led anterior of the aorta to the LAD, the left IMA to the lateral wall. In the SIMA group, the LAD was revascularized with the left IMA. Additional bypasses were performed with vein grafts.
The 30-day mortality was 1.6% in the BIMA group, 1.7% in the SIMA group in patients under 70 years, and 4.1% (BIMA) and 4.0% (SIMA) in patients over 70 years (p = n.s.). A significantly higher blood loss was observed in the BIMA group (BIMA 979 +/- 708 ml; SIMA 790 +/- 575 ml; p < 0.05). The rethoracotomy rate due to bleeding was significantly higher in patients with BIMA (4.1%) compared to those with SIMA (2.5%; p < 0.05). In patients with a body mass index (BMI) of less than 27, no significant difference could be found (SIMA 2.8%, BIMA 3.4%; p = n.s.). Patients with a BMI > 27 showed a significantly higher rethoractomy rate (SIMA 2.2%; BIMA 4.9%). A higher incidence of sternal instabilities could be observed in the BIMA group (4.2%; p < 0.05). Diabetes mellitus could not be identified as an independent risk factor for sternal complications (SIMA 2.9%; BIMA 5.0%; p = n.s.).
CABG using both IMAs can be performed in nearly all patients as a routine method with good clinical results and low mortality. Bleeding in the BIMA group within 48 h was increased. BMI > 27 could be identified as a risk factor for sternal complications, but not diabetes mellitus or age over 70 years.
双侧胸廓内动脉（BIMA）移植的冠状动脉旁路移植术（CABG）可改善心脏疾病发病率和死亡率的长期结果。与单根胸廓内动脉（SIMA）移植的患者相比，出血和伤口并发症发生率增加仍存在争议。本研究的目的是比较接受BIMA原位移植和SIMA原位移植的CABG患者的手术结果，特别是确定与患者相关的危险因素，如肥胖、糖尿病和70岁以上年龄。
在1996年1月至1999年9月期间接受手术的5144例患者中，对接受单纯CABG（n = 3671）且采用BIMA或SIMA的患者进行回顾性分析。在BIMA组中，患者（n = 1478）的平均年龄为64.0岁；平均射血分数（EF）为62.1%。在SIMA组（n = 2184）中，平均年龄为65.4岁，平均EF为60.6%（无显著差异）。在BIMA组中，右侧胸廓内动脉经主动脉前方引至左前降支（LAD），左侧胸廓内动脉引至侧壁。在SIMA组中，LAD由左侧胸廓内动脉进行血运重建。其他旁路采用静脉移植。
70岁以下患者中，BIMA组30天死亡率为1.6%，SIMA组为1.7%；70岁以上患者中，BIMA组为4.1%，SIMA组为4.0%（p = 无显著差异）。BIMA组观察到显著更高的失血量（BIMA 979 ± 708 ml；SIMA 790 ± 575 ml；p < 0.05）。与SIMA患者（2.5%）相比，BIMA患者因出血导致的再次开胸率显著更高（4.1%；p < 0.05）。体重指数（BMI）小于27的患者中，未发现显著差异（SIMA 2.8%，BIMA 3.4%；p = 无显著差异）。BMI > 27的患者再次开胸率显著更高（SIMA 2.2%；BIMA 4.9%）。在BIMA组中可观察到更高的胸骨不稳定发生率（4.2%；p < 0.05）。糖尿病未被确定为胸骨并发症的独立危险因素（SIMA 2.9%；BIMA 5.0%；p = 无显著差异）。
几乎所有患者均可将使用双侧胸廓内动脉的CABG作为常规方法进行，临床效果良好且死亡率低。BIMA组48小时内出血增加。BMI > 27可被确定为胸骨并发症的危险因素，但糖尿病或70岁以上年龄不是。
