用于不稳定型心绞痛非选择性手术血运重建的双侧去骨化胸廓内动脉。

Skeletonized bilateral internal mammary arteries for non-elective surgical revascularization in unstable angina.

作者信息

Bonacchi Massimo, Prifti Edvin, Maiani Massimo, Giunti Gabriele, Leacche Marzia

机构信息

Department of Cardiac Surgery, Cattedra e Scuola di Specializzazione in Cardiochirurgia, University of Florence, Viale Morgagni, 85, Careggi, 50134 Firenze, Italy.

出版信息

Eur J Cardiothorac Surg. 2005 Jul;28(1):120-6. doi: 10.1016/j.ejcts.2005.03.031.

DOI:10.1016/j.ejcts.2005.03.031

PMID:15939611

Abstract

OBJECTIVE

The aim of this study was to evaluate the feasibility, safety and outcome of skeletonized bilateral internal mammary arteries (BIMA) in patients with unstable angina (UA) undergoing non-elective myocardial revascularization.

METHODS

Between January 1997 and December 2003, 758 patients, mean age 62+/-12 years, underwent non-elective coronary artery bypass grafting (CABG) for unstable angina. Two hundred and five (27%) were operated emergently and 503 (73%) urgently. BIMA were employed in 320 (42%) patients (Group B) and isolated left IMA and/or saphenous vein grafts in the remaining 438 (58%) patients (Group M).

RESULTS

In-hospital mortality (B = 5.9% and M = 5.3%), and perioperative myocardial infarction (B = 2.2%; M = 1.96%) were similar between the two groups (P = ns). Actuarial survival at 1, 3 and 7 years was 98.7, 97.5 and 96.2% in B and 99, 94.3 and 88.4% in M (P < 0.05 at 7 years follow-up). At 7 years follow-up, the event-free cardiac survival (92 vs. 87%, P = 0.021), angina-free survival (98.6 vs. 94%, P = 0.039), reoperation-free cardiac survival (98 vs. 95%, P = 0.04) and infarct-free cardiac survival (98.7 vs. 96%, P = 0.05) were better in Group B. Multivariate analysis identified age > 65 years (P = 0.02), LVEF < 35% (P = 0.01), > 1 ischemic irreversible area (P = 0.03) as independent predictors for late deaths, while the use of the LIMA (P=0.006) and both mammary arteries (P=0.001) decreased the risk of late deaths.

CONCLUSIONS

The use of BIMA in non-elective CABG for UA is safe and effective. Mid-term outcome, however, are superior with improved freedom from cardiac death, from coronary reintervention and from myocardial infarction.

摘要

目的

本研究旨在评估在接受非选择性心肌血运重建的不稳定型心绞痛（UA）患者中，游离双侧乳内动脉（BIMA）的可行性、安全性及疗效。

方法

1997年1月至2003年12月期间，758例平均年龄为62±12岁的患者因不稳定型心绞痛接受了非选择性冠状动脉旁路移植术（CABG）。其中205例（27%）为急诊手术，503例（73%）为紧急手术。320例（42%）患者采用了BIMA（B组），其余438例（58%）患者采用了单纯左乳内动脉和/或大隐静脉移植（M组）。

结果

两组患者的院内死亡率（B组为5.9%，M组为5.3%）和围手术期心肌梗死发生率（B组为2.2%；M组为1.96%）相似（P = 无显著性差异）。B组1年、3年和7年的精算生存率分别为98.7%、97.5%和96.2%，M组分别为99%、94.3%和88.4%（随访7年时P < 0.05）。在7年随访时，B组的无事件心脏生存率（92%对87%，P = 0.021）、无心绞痛生存率（98.6%对94%，P = 0.039）、无再次手术心脏生存率（98%对95%，P = 0.04）和无梗死心脏生存率（98.7%对96%，P = 0.05）均优于M组。多因素分析确定年龄>65岁（P = 0.02）、左心室射血分数<35%（P = 0.01）、>1个缺血不可逆区域（P = 0.03）为晚期死亡的独立预测因素，而使用左乳内动脉（P = 0.006）和双侧乳内动脉（P = 0.001）可降低晚期死亡风险。