Aarnio P, Kettunen S, Harjula A
Department of Thoracic and Cardiovascular Surgery, University Central Hospital, Helsinki, Finland.
Scand J Thorac Cardiovasc Surg. 1991;25(3):175-8. doi: 10.3109/14017439109099035.
The long-term patency of internal mammary artery (IMA) grafts in coronary bypass surgery is superior to that of saphenous vein grafts. To investigate if bilateral IMA grafting increases the complication rate, especially pleural problems, 100 patients with bilateral and 100 with unilateral IMA grafts were retrospectively studied. Preoperatively the groups did not differ in age, previous myocardial infarction, ejection fraction, NYHA classification or previous respiratory disease, but the coronary artery status was poorer in the bilateral IMA group. Postoperative pleural drainage was greater after bilateral IMA grafting (1074 vs. 497 ml, p less than 0.0001). Reoperation was required for bleeding in 10% of the patients with unilateral, and 20% of those with bilateral IMA grafting (p less than 0.05), and more blood was transfused in the latter group (5.9 vs. 4.7 units, p less than 0.01). Pleural effusion at discharge from hospital or 3 months postoperatively, pain in the sternotomy wound, pain on breathing and postoperative use of nitroglycerin did not differ significantly between the groups. Bilateral IMA grafting thus led to more bleeding and reoperations than single IMA grafting, but did not cause excessive pulmonary complications.
在冠状动脉搭桥手术中，乳内动脉（IMA）移植物的长期通畅性优于大隐静脉移植物。为了研究双侧IMA移植是否会增加并发症发生率，尤其是胸膜相关问题，对100例行双侧IMA移植的患者和100例行单侧IMA移植的患者进行了回顾性研究。术前，两组患者在年龄、既往心肌梗死、射血分数、纽约心脏协会（NYHA）分级或既往呼吸系统疾病方面无差异，但双侧IMA组的冠状动脉状况较差。双侧IMA移植术后的胸腔引流量更大（1074 vs. 497 ml，p<0.0001）。单侧IMA移植患者中有10%因出血需要再次手术，双侧IMA移植患者中有20%需要再次手术（p<0.05），且后一组输血更多（5.9 vs. 4.7单位，p<0.01）。两组患者出院时或术后3个月的胸腔积液、胸骨切开伤口疼痛、呼吸时疼痛以及术后硝酸甘油的使用情况无显著差异。因此，双侧IMA移植比单侧IMA移植导致更多的出血和再次手术，但并未引起过多的肺部并发症。
