Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu City, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2010 Nov;140(5):1040-5. doi: 10.1016/j.jtcvs.2009.11.069. Epub 2010 Feb 26.
This study assessed the safety and efficacy of off-pump bilateral internal thoracic artery grafting in patients with left main disease.
We reviewed the records of 768 patients who underwent off-pump bilateral internal thoracic artery grafting between September 2004 and June 2009. Bilateral internal thoracic artery grafts were used for the left coronary system in all patients, of whom 268 had left main disease and 500 did not. We compared operative and postoperative variables and early and 1-year angiographic patency rates of the bilateral internal thoracic artery between the 2 groups.
The perioperative mortality and incidence of postoperative complications were not significantly different between groups. In patients without left main disease, the left and right internal thoracic arteries were used for the left anterior descending artery in 87.4% and 12.2% of patients, respectively. In patients with left main disease, the left and right internal thoracic arteries were used for the left anterior descending artery in 70.5% and 29.1% of patients, respectively. In patients with left main disease, the patency rates for the left and right internal thoracic arteries at 1-year postoperative follow-up were 97.0% and 93.2%, respectively. In patients without left main disease, the patency rates for the left and right internal thoracic arteries at 1-year follow-up were 97.6% and 91.6%, respectively. The patency rates of the left and right internal thoracic arteries did not differ significantly in patients with or without left main disease (P = .9803 and P = .7205 in left and right internal thoracic arteries, respectively).
Off-pump bilateral internal thoracic artery grafting was safe and effective in patients with left main disease. The patency rates of both grafts were comparable to those of patients without left main disease.
本研究评估了非体外循环双侧内乳动脉搭桥术在左主干病变患者中的安全性和疗效。
我们回顾了 2004 年 9 月至 2009 年 6 月期间接受非体外循环双侧内乳动脉搭桥术的 768 例患者的记录。所有患者的左冠状动脉系统均使用双侧内乳动脉移植，其中 268 例患者有左主干病变，500 例患者无左主干病变。我们比较了两组患者的手术和术后变量以及双侧内乳动脉的早期和 1 年血管造影通畅率。
两组患者的围手术期死亡率和术后并发症发生率无显著差异。在无左主干病变的患者中，左内乳动脉分别用于前降支动脉的 87.4%和 12.2%的患者，右内乳动脉分别用于前降支动脉的 12.2%和 87.4%的患者。在有左主干病变的患者中，左内乳动脉分别用于前降支动脉的 70.5%和 29.1%的患者，右内乳动脉分别用于前降支动脉的 29.1%和 70.5%的患者。在有左主干病变的患者中，左内乳动脉和右内乳动脉在术后 1 年的通畅率分别为 97.0%和 93.2%。在无左主干病变的患者中，左内乳动脉和右内乳动脉在术后 1 年的通畅率分别为 97.6%和 91.6%。有左主干病变和无左主干病变的患者的左内乳动脉和右内乳动脉的通畅率无显著差异（左内乳动脉 P =.9803，右内乳动脉 P =.7205）。
非体外循环双侧内乳动脉搭桥术在左主干病变患者中是安全有效的。两种移植物的通畅率与无左主干病变的患者相似。
