Kim Chang Young, Hwang Ho Young, Paeng Jin Chul, Lee Dong Soo, Kim Ki-Bong
Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Go-yang, South Korea.
Ann Thorac Surg. 2009 Nov;88(5):1419-25. doi: 10.1016/j.athoracsur.2009.07.004.
Late improvements in myocardial perfusion and thickening after off-pump revascularization were evaluated during a 5-year follow-up by myocardial single photon emission computed tomography.
Between 2001 and 2003, 68 patients who underwent off-pump coronary artery bypass grafting using bilateral internal thoracic artery Y-composite (group Y, n = 41) or in situ (group I, n = 27) grafts for revascularization of the left coronary artery territory were enrolled. Myocardial single photon emission computed tomography was performed preoperatively and at 3 months, 1 year, and 5 years postoperatively. A 20-segment model was adopted. As an indicator of ischemic myocardium, the reversibility score was defined as a measure of rest minus stress perfusion values. A total of 374 segments that showed a reversibility score of > or = 7 preoperatively were included. Z values for thickening were calculated as observed values minus reference values divided by the reference standard deviation. Mixed-model analysis was used to compare the two groups with respect to the time sequences of myocardial reversibility scores and Z values.
Postoperative reversibility scores improved significantly at 3 months (p < 0.001) and further at 5 years (p = 0.030). Postoperative Z values improved significantly at 3 months (p < 0.001), between 1 year and 5 years (p = 0.006), and further at 5 years (p = 0.004). In the mixed models, there were no significant differences in reversibility scores and Z values between groups Y and I at any point.
Reversibility scores and thickening gradually improved during 5 years after off-pump revascularization using bilateral internal thoracic arteries. No significant differences were observed between Y-composite and bilateral in situ grafts in terms of reversibility score and thickening improvement at 5 years postoperatively.
在一项为期5年的随访中，通过心肌单光子发射计算机断层扫描评估非体外循环冠状动脉搭桥术后心肌灌注和增厚的晚期改善情况。
2001年至2003年期间，纳入了68例接受非体外循环冠状动脉搭桥术的患者，这些患者使用双侧胸廓内动脉Y型复合移植物（Y组，n = 41）或原位移植物（I组，n = 27）对左冠状动脉区域进行血运重建。术前以及术后3个月、1年和5年进行心肌单光子发射计算机断层扫描。采用20节段模型。作为缺血心肌的指标，可逆性评分定义为静息灌注值减去负荷灌注值的差值。总共纳入了术前可逆性评分≥7的374个节段。增厚的Z值计算为观察值减去参考值再除以参考标准差。采用混合模型分析比较两组在心肌可逆性评分和Z值时间序列方面的差异。
术后可逆性评分在3个月时显著改善（p < 0.001），在5年时进一步改善（p = 0.030）。术后Z值在3个月时显著改善（p < 0.001），在1年至5年之间（p = 0.006），并在5年时进一步改善（p = 0.004）。在混合模型中，Y组和I组在任何时间点的可逆性评分和Z值均无显著差异。
使用双侧胸廓内动脉进行非体外循环血运重建术后5年内，可逆性评分和增厚情况逐渐改善。术后5年时，Y型复合移植物和双侧原位移植物在可逆性评分和增厚改善方面未观察到显著差异。
