Wareing T H, Saffitz J E, Kouchoukos N T
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo.
Circulation. 1990 Nov;82(5 Suppl):IV224-8.
The indications for use of the internal mammary artery as a coronary bypass conduit in older patients are not clearly established. Between January 1985 and December 1988, 786 patients received single internal mammary artery grafts alone (717) or in conjunction with other procedures (69). Of these patients, 341 were 65 years of age or older (mean, 69.3 years). This group was compared with those patients less than 65 years of age (mean, 56.2 years). There were no significant differences between the two groups in the incidence of diabetes mellitus; the number of distal coronary anastomoses; left ventricular wall motion score; the frequency of isolated bypass procedures, reoperations, or emergent operations; or the durations of aortic clamping and cardiopulmonary bypass. The older group contained more women (34.9% versus 20.7%) and more patients with left main coronary artery disease (15.5% versus 9.4%) (p less than 0.01). No significant differences in the frequency of reoperation for hemorrhage, perioperative infarction, neurological deficits, requirements for intra-aortic balloon pumping, sternal wound infections, necessity for prolonged ventilatory support, or 30-day mortality (2.7% versus 3.2%) were observed. The length of postoperative hospitalization was greater in the older group (11.8 versus 10.2 days) (p = 0.02). Blinded histological examination of biopsies from 61 internal mammary artery grafts (34 patients less than 65 years, 27 patients greater than or equal to 65 years) showed no significant differences in luminal area or wall thickness. No significant degenerative changes were observed in either group. We conclude that the use of the internal mammary artery for bypass grafting in older patients is safe and may provide long-term benefit.
在老年患者中，使用乳内动脉作为冠状动脉搭桥管道的适应证尚未明确确立。在1985年1月至1988年12月期间，786例患者单独接受了单根乳内动脉移植（717例）或与其他手术联合进行（69例）。在这些患者中，341例年龄在65岁及以上（平均69.3岁）。将该组患者与年龄小于65岁（平均56.2岁）的患者进行比较。两组在糖尿病发病率、冠状动脉远端吻合数量、左心室壁运动评分、单纯搭桥手术、再次手术或急诊手术的频率，以及主动脉阻断和体外循环持续时间方面均无显著差异。老年组女性更多（34.9%对20.7%），左主干冠状动脉疾病患者更多（15.5%对9.4%）（p<0.01）。在出血再次手术频率、围手术期梗死、神经功能缺损、主动脉内球囊反搏需求、胸骨伤口感染、延长通气支持的必要性或30天死亡率（2.7%对3.2%）方面未观察到显著差异。老年组术后住院时间更长（11.8天对10.2天）（p = 0.02）。对61根乳内动脉移植物（34例年龄小于65岁的患者，27例年龄大于或等于65岁的患者）的活检标本进行盲法组织学检查，结果显示管腔面积或管壁厚度无显著差异。两组均未观察到明显的退行性改变。我们得出结论，在老年患者中使用乳内动脉进行搭桥手术是安全的，并且可能带来长期益处。
