Galbut D L, Traad E A, Dorman M J, DeWitt P L, Larsen P B, Kurlansky P A, Button J H, Ally J M, Gentsch T O
Cardiovascular Associates, Miami Heart Institute, Florida.
Ann Thorac Surg. 1991 Jul;52(1):20-7; discussion 27-8. doi: 10.1016/0003-4975(91)91411-n.
Bilateral internal mammary artery grafting is recognized as a preferred method of myocardial revascularization. However, its efficacy in coronary bypass reoperation has not been clearly established. From January 1982 through June 1989, 88 patients underwent coronary bypass reoperation with bilateral internal mammary artery grafts. Results were compared with those for a subset of 88 patients receiving primary revascularization with bilateral internal mammary artery grafts who were computer matched for sex, age, left ventricular function, anginal classification, and left main coronary artery disease. In each group, 62.5% (55 patients) had unstable angina, 43.2% (38 patients) had reduced ejection fraction, and 21.6% (19 patients) in the reoperation group and 20.5% (18 patients) in the reference group had left main coronary artery disease. Hospital mortality for the reoperation group was 6.8% (6 patients) and for the reference group, 3.4% (3 patients). No significant difference was found in the incidence of reoperation for bleeding, sternal infection, or stroke in the two groups. The incidence of respiratory insufficiency in the reoperation group was 13.6% (12 patients) and in the reference group, 3.4% (3 patients) (p less than 0.015). Recurrent angina occurred in 13.7% (10 patients) of patients in the reoperation group and 13.3% (10 patients) in the reference group. The long-term survival at 5 years for the reoperation group was 85.3% +/- 5.6% (+/- standard error of the mean) and for the reference group, 91.6% +/- 3.1%. No significant difference was found in the equality of survival distribution for the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
双侧乳内动脉移植被认为是心肌血运重建的一种首选方法。然而，其在冠状动脉搭桥再次手术中的疗效尚未明确确立。从1982年1月至1989年6月，88例患者接受了双侧乳内动脉移植的冠状动脉搭桥再次手术。将结果与88例接受双侧乳内动脉移植初次血运重建的患者亚组进行比较，这些患者在性别、年龄、左心室功能、心绞痛分级和左主干冠状动脉疾病方面进行了计算机匹配。每组中，62.5%（55例患者）患有不稳定型心绞痛，43.2%（38例患者）射血分数降低，再次手术组中21.6%（19例患者）和参照组中20.5%（18例患者）患有左主干冠状动脉疾病。再次手术组的医院死亡率为6.8%（6例患者），参照组为3.4%（3例患者）。两组在出血、胸骨感染或中风的再次手术发生率方面未发现显著差异。再次手术组呼吸功能不全的发生率为13.6%（12例患者），参照组为3.4%（3例患者）（p小于0.015）。再次手术组13.7%（10例患者）和参照组13.3%（10例患者）出现复发性心绞痛。再次手术组5年的长期生存率为85.3%±5.6%（±平均标准误差），参照组为91.6%±3.1%。两组在生存分布的平等性方面未发现显著差异。（摘要截短至250字）
