Calafiore Antonio Maria, Di Mauro Michele
Universty of CataniaVia Citelli, Division of Cardiac Surgery, 96100 Catania, Italy.
Expert Rev Cardiovasc Ther. 2006 May;4(3):395-403. doi: 10.1586/14779072.4.3.395.
The superiority of the left internal mammary artery over the saphenous vein graft led many surgeons to adopt bilateral internal mammary artery (BIMA) as a good surgical option for further improving late outcome of patients undergoing myocardial revascularization. However, routine use of BIMA was limited by some potential drawbacks: the increase of deep sternal wound problems, especially in diabetic patients; the shortness of right internal mammary artery (RIMA), which limited its utilization as an in situ graft; the low patency rate if grafted to the right coronary artery; and the longer operative time. The skeletonization of the internal mammary artery along with a better glucose control in diabetic patients significantly reduced the incidence of deep sternal problems. Another problem to solve was finding the optimal target of the RIMA. The general consensus is that RIMA appears to be more efficient if grafted to the lateral wall. The Y or T configuration of double mammary arteries could be more helpful to reach the lateral target vessels. Finally, recent reports clearly demonstrate the superiority of BIMA over single internal mammary artery in terms of survival or quality of life. The latter finding has also been reported in diabetic patients.
左乳内动脉优于大隐静脉移植血管，这使得许多外科医生采用双侧乳内动脉（BIMA）作为进一步改善心肌血运重建患者远期疗效的良好手术选择。然而，BIMA的常规使用受到一些潜在缺点的限制：深部胸骨伤口问题增加，尤其是在糖尿病患者中；右乳内动脉（RIMA）较短，限制了其作为原位移植血管的应用；如果移植到右冠状动脉，通畅率较低；以及手术时间较长。乳内动脉的骨骼化以及糖尿病患者更好的血糖控制显著降低了深部胸骨问题的发生率。另一个需要解决的问题是找到RIMA的最佳靶点。普遍的共识是，如果将RIMA移植到侧壁，似乎更有效。双乳动脉的Y形或T形配置可能更有助于到达外侧目标血管。最后，最近的报告清楚地表明，在生存或生活质量方面，BIMA优于单乳内动脉。后者的发现也在糖尿病患者中得到了报道。
