Kleisli Thomas, Cheng Wen, Jacobs Milagros J, Mirocha James, Derobertis Michele A, Kass Robert M, Blanche Carlos, Fontana Gregory P, Raissi Sharo S, Magliato Kathy E, Trento Alfredo
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
J Thorac Cardiovasc Surg. 2005 Jun;129(6):1283-91. doi: 10.1016/j.jtcvs.2004.12.034.
Complete revascularization has been the standard for coronary bypass grafting. However, surgical intervention has evolved with increasing use of arterial conduits and off-pump techniques.
Patients undergoing non-redo bypass surgery from January 1998 through December 2000 were followed up with questionnaires and telephone contact. Incomplete revascularization was defined as absence of bypass grafts placed to a coronary territory supplied by a vessel with 50% or greater stenosis.
One thousand thirty-four patients were followed for a mean of 3.3 +/- 1.6 years. Complete revascularization was found in 937 (90.6%) patients, and incomplete revascularization was found in 97 (9.4%) patients. Eight hundred twenty-seven (80.4%) patients underwent on-pump operations, and 207 (19.6%) underwent off-pump operations. Incomplete revascularization was more prevalent in off-pump versus on-pump operations (21.7% vs 6.3%, P < .001). Multivariable Cox regression analysis indicated that in-hospital cerebrovascular accidents (hazard ratio, 5.49; P < .001), chronic obstructive pulmonary disease (hazard ratio, 1.97; P = .019), and incomplete revascularization (hazard ratio, 1.85; P = .040) predicted an increased hazard (risk) of cardiac death. Left internal thoracic artery (hazard ratio, 0.38; P = .047), right internal thoracic artery (hazard ratio, 0.25; P = .019), and radial artery (hazard ratio, 0.36; P < .001) grafting reduced the risk of cardiac death. The 5-year unadjusted survival rate was 52.6% versus 82.4% in patients undergoing incomplete and complete revascularization ( P < .001), with cardiac survival rates of 74.5% versus 93.1%, respectively ( P < .001). However, this difference in cardiac survival was smaller in octogenarians with incomplete versus complete revascularizations (77.4% vs 87.6%, P = .101) and was essentially absent in off-pump versus on-pump operations if complete revascularization was achieved in both cases (93.6% vs 93.1%, P > .200).
Complete revascularization and arterial grafting improve 5-year survival. Off-pump techniques do not affect survival. Complete revascularization should be performed whenever possible.
完全血运重建一直是冠状动脉搭桥术的标准。然而，随着动脉血管桥和非体外循环技术的更多应用，外科干预已经有所发展。
对1998年1月至2000年12月期间接受非再次搭桥手术的患者进行问卷调查和电话随访。不完全血运重建定义为未对狭窄程度达50%或更高的血管所供应的冠状动脉区域进行搭桥。
1034例患者平均随访3.3±1.6年。937例（90.6%）患者实现了完全血运重建，97例（9.4%）患者为不完全血运重建。827例（80.4%）患者接受了体外循环手术，207例（19.6%）接受了非体外循环手术。不完全血运重建在非体外循环手术中比在体外循环手术中更常见（21.7%对6.3%，P<.001）。多变量Cox回归分析表明，院内脑血管意外（风险比，5.49；P<.001）、慢性阻塞性肺疾病（风险比，1.97；P = .019）和不完全血运重建（风险比，1.85；P = .040）预示着心脏死亡风险增加。左内乳动脉（风险比，0.38；P = .047）、右内乳动脉（风险比，0.25；P = .019）和桡动脉（风险比，0.36；P<.001）搭桥可降低心脏死亡风险。不完全血运重建和完全血运重建患者的5年未调整生存率分别为52.6%和82.4%（P<.001），心脏生存率分别为74.5%和93.1%（P<.001）。然而，在不完全血运重建与完全血运重建的八旬老人中，这种心脏生存差异较小（77.4%对87.6%，P = .101），并且如果两种情况下均实现完全血运重建，非体外循环手术与体外循环手术之间基本不存在差异（93.6%对93.1%，P>.200）。
完全血运重建和动脉搭桥可提高5年生存率。非体外循环技术不影响生存率。应尽可能进行完全血运重建。
Zotero 插件