Ochsner J L, Moseley P W, Mills N L, Bower P J
Ann Thorac Surg. 1977 Feb;23(2):118-21. doi: 10.1016/s0003-4975(10)64083-0.
A study was made of 100 patients who had undergone internal mammary artery myocardial implantation 7 to 10 years previously. Forty-two patients had single implantation with or without a free omental graft, and 54 received double implantations. Four patients had a single internal mammary artery implant plus a single aortocoronary bypass graft. Eleven patients died at operation or within the first month, and 17 died from 1 to 7 years following operation. Two were lost to follow-up, and 15 refused follow-up angiograms. From 7 to 10 years postoperatively, angiographic studies were performed on 55 patients with 73 internal mammary artery implants. Of these 73 implants, 17 (23%) were occluded; 10 (14%) were patent but did not show myocardial filling; 15 (21%) showed myocardial blush or filling of small vessels; and 31 (42%) showed filling of a major coronary artery. The patency rate correlated well with the amount of coronary disease and slightly with the amount of symptomatic improvement. This study shows that the Vineberg operation is physiologically sound; however, the ideal candidates are those patients with coronary arteries of adequate size who could benefit more by direct perfusion.
对100例7至10年前接受过胸廓内动脉心肌植入术的患者进行了一项研究。42例患者进行了单次植入，有无游离网膜移植，54例接受了双次植入。4例患者进行了单次胸廓内动脉植入加单次主动脉冠状动脉搭桥移植。11例患者在手术中或术后第一个月内死亡，17例在术后1至7年死亡。2例失访，15例拒绝接受随访血管造影。术后7至10年，对55例植入73条胸廓内动脉的患者进行了血管造影研究。在这73条植入血管中，17条（23%）闭塞；10条（14%）通畅但未显示心肌灌注；15条（21%）显示心肌充血或小血管灌注；31条（42%）显示主要冠状动脉灌注。通畅率与冠心病的严重程度相关性良好，与症状改善程度相关性稍弱。这项研究表明，温伯格手术在生理上是合理的；然而，理想的候选者是那些冠状动脉大小合适、能从直接灌注中获益更多的患者。
