当心肌血运重建用作辅助性血运重建时，患者预后得到改善。
Improved patient outcomes when transmyocardial revascularization is used as adjunctive revascularization.
作者信息
Wehberg Kurt E, Julian J Stephens, Todd James C, Ogburn Nicholas, Klopp Edward, Buchness Michael
机构信息
Peninsula Heart Center, Salisbury, Maryland, USA.
出版信息
Heart Surg Forum. 2003;6(5):328-30.
BACKGROUND
Transmyocardial revascularization (TMR) has been recently used to treat patients with angina for whom angioplasty/stenting and/or coronary artery bypass grafting (CABG) is no longer an option.
METHODS
A retrospective review of 255 consecutive patients who required CABG was done. Group 1 patients (n = 219) underwent complete revascularization with CABG alone. Group 2 patients (n = 36) received CABG plus TMR. TMR was performed in regions of nongraftable coronary targets. Indications for surgery in both groups were Canadian Cardiovascular Society angina scores III or IV and an ejection fraction > or = 30%. Exclusion criteria were an emergency procedure within 12 hours, unstable angina, or an acute myocardial infarction within 72 hours. Thirty-day outcomes of the two groups were compared. The means +/- SD of patient ages (63.3 +/- 1.6 years versus 65.4 +/- 1.4 years) and ejection fractions (51.6% +/- 0.9% versus 48.5% +/- 1.6%) were similar for the two groups.
RESULTS
The number of grafts performed and operating room times for the two groups were similar (3.1 +/- 0.1 versus 2.9 +/- 0.1 and 276.7 +/- 4.4 minutes versus 272.3 +/- 10.7 minutes, respectively). Intensive care unit times and lengths of stay (emergency room to discharge) were significantly shorter in the CABG plus TMR group (2.1 +/- 0.2 days versus 1.6 +/- 0.2 days [P < .001] and 8.2 +/- 0.4 days versus 7.1 +/-0.6 days [P < .001], respectively). The 30-day readmission rate was lower in the CABG plus TMR group (7.8% versus 2.8%; P < .5). The frequency of atrial fibrillation was also significantly lower in the CABG plus TMR group (37.4% versus 16.7%; P < .025). Major adverse outcomes, such as reoperation for bleeding, respiratory failure, renal failure, stroke, and mortality were similar in the two groups, although there were no mortalities in the CABG plus TMR group.
CONCLUSION
TMR as an adjunctive revascularization to CABG in selected patients with limited options may improve in-hospital outcomes.
背景
心肌血运重建术（TMR）最近已被用于治疗那些不再适合进行血管成形术/支架置入术和/或冠状动脉旁路移植术（CABG）的心绞痛患者。
方法
对255例连续需要进行CABG的患者进行回顾性研究。第1组患者（n = 219）仅接受CABG完全血运重建。第2组患者（n = 36）接受CABG加TMR。TMR在不可移植冠状动脉靶点区域进行。两组患者的手术指征均为加拿大心血管学会心绞痛评分III或IV级且射血分数≥30%。排除标准为12小时内的急诊手术、不稳定型心绞痛或72小时内的急性心肌梗死。比较两组患者30天的结局。两组患者的平均年龄（63.3±1.6岁对65.4±1.4岁）和射血分数（51.6%±0.9%对48.5%±1.6%）相似。
结果
两组患者的移植血管数量和手术时间相似（分别为3.1±0.1对2.9±0.1以及276.7±4.4分钟对272.3±10.7分钟）。CABG加TMR组的重症监护病房时间和住院时间（从急诊室到出院）明显更短（分别为2.1±0.2天对1.6±0.2天[P <.001]以及8.2±0.4天对7.1±0.6天[P <.001]）。CABG加TMR组的30天再入院率更低（7.8%对2.8%；P <.5）。CABG加TMR组的房颤发生率也显著更低（37.4%对16.7%；P <.025）。两组患者的主要不良结局，如因出血、呼吸衰竭、肾衰竭、中风而再次手术以及死亡率相似，尽管CABG加TMR组无死亡病例。
结论
对于选择有限的特定患者，TMR作为CABG的辅助血运重建术可能会改善住院结局。
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