Allen Keith B
Department of Cardiothoracic Surgery, Heart Center of Indiana, Indianapolis, Indiana 46290, USA.
Semin Thorac Cardiovasc Surg. 2006 Spring;18(1):52-7. doi: 10.1053/j.semtcvs.2005.12.001.
Many patients with angina related to coronary artery disease respond to medical management or can be completely revascularized using available percutaneous coronary interventions or coronary artery bypass grafting (CABG). There is evidence, however, to indicate that up to 25% of patients are incompletely revascularized following CABG and that incomplete revascularization is a significant independent predictor of early and late mortality and adverse events. Transmyocardial revascularization (TMR) is a surgical option for patients with debilitating angina due to coronary artery disease in areas of the heart not amenable to complete revascularization using conventional treatments. In randomized, 1-year controlled trials with long-term follow-up and in additional clinical experience, TMR performed adjunctively to CABG in patients who would be incompletely revascularized by CABG alone has yielded significantly improved clinical outcomes. Based on these published results, the Society of Thoracic Surgeons has issued a practice guideline recommending adjunctive TMR in this difficult patient group.
许多与冠状动脉疾病相关的心绞痛患者对药物治疗有反应，或者可以通过现有的经皮冠状动脉介入治疗或冠状动脉旁路移植术（CABG）实现完全血运重建。然而，有证据表明，高达25%的患者在CABG后血运重建不完全，且不完全血运重建是早期和晚期死亡率及不良事件的重要独立预测因素。经心肌血运重建术（TMR）是一种手术选择，适用于因冠状动脉疾病导致严重心绞痛且心脏区域无法通过传统治疗实现完全血运重建的患者。在进行长期随访的随机1年对照试验以及其他临床经验中，对于仅行CABG无法实现完全血运重建的患者，在CABG的基础上辅助进行TMR已显著改善了临床结局。基于这些已发表的结果，胸外科医师协会发布了一项实践指南，建议在这一困难患者群体中采用辅助性TMR。
