Department of Cardiac Surgery, University of Brescia, Brescia, Italy.
Eur J Cardiothorac Surg. 2013 Aug;44(2):288-93; discussion 293-4. doi: 10.1093/ejcts/ezt016. Epub 2013 Feb 26.
Minimally invasive hybrid revascularization (MIHR) by means of the left mammary artery on the left anterior descending artery [minimally invasive direct coronary artery bypass (MIDCAB)] combined with percutaneous coronary interventions (PCI) stenting may be an alternative to conventional coronary artery bypass grafting through sternotomy or multiple PCI. The purpose of this study is to retrospectively evaluate the long-term outcomes of this strategy.
Since May 1997 up to January 2011, 810 MIDCAB have been performed as isolated revascularization in 644 patients. Since 2004, MIDCAB, as a part of hybrid revascularization, was associated with PCI in 166 patients.
In the MIDCAB group, mean age was 64.6 ± 12.0, with 83.8% males. Two-vessel disease was 62.4%, three-vessel disease 37.6%. Overall mortality was 0.24%, perioperative acute myocardial infarction-1.6%, early reoperation-0.74%, reopening for bleeding-1.2%, case rate of haemotrasfusion-3.1%, with a mean hospital postoperative stay of 4 ± 2.5 days. Postoperative angiographic control prior to PCI and in symptomatic patients showed patent left internal mammary artery in 100% of cases. PCI was performed in 166 patients, 64.2% before MIDCAB and 35.8% after surgery (interval 2.2 ± 1.3 months). The mean follow-up in the MIDCAB group was 8.4 ± 3.2 years. In the MIHR group, at the mean follow-up of 4.5 ± 2.3 years, freedom from related cardiac death was 93% with freedom from cardiac reintervention of 83%.
Our 13-year experience with MIDCAB demonstrates that the operation is safe and associated with a very low incidence of early and late complications. The hybrid approach provided excellent long-term outcome in terms of freedom from cardiac death and reoperation. Accurate patient selection, as well the timing of the hybrid procedure, is mandatory to optimize surgical and PCI results.
通过左前降支的左乳内动脉（微创直接冠状动脉旁路移植术 [微创冠状动脉旁路移植术（MIDCAB）]）与经皮冠状动脉介入治疗（PCI）支架置入相结合的微创杂交血运重建术（MIHR），可能是经胸骨切开术或多次 PCI 的传统冠状动脉旁路移植术的替代方法。本研究的目的是回顾性评估该策略的长期结果。
自 1997 年 5 月至 2011 年 1 月，644 例患者接受了 810 例 MIDCAB 作为孤立性血运重建术。自 2004 年以来，MIDCAB 作为杂交血运重建术的一部分，与 166 例患者的 PCI 联合进行。
在 MIDCAB 组中，平均年龄为 64.6±12.0 岁，男性占 83.8%。双支血管疾病占 62.4%，三支血管疾病占 37.6%。总体死亡率为 0.24%，围手术期急性心肌梗死 1.6%，早期再次手术 0.74%，因出血再开放 1.2%，输血量 3.1%，平均术后住院时间为 4±2.5 天。在进行 PCI 之前和有症状的患者中进行的术后血管造影检查显示，100%的病例左内乳动脉通畅。在 166 例患者中进行了 PCI，64.2%在 MIDCAB 之前进行，35.8%在手术后进行（间隔 2.2±1.3 个月）。MIDCAB 组的平均随访时间为 8.4±3.2 年。在 MIHR 组中，平均随访 4.5±2.3 年后，相关心脏死亡的无事件生存率为 93%，心脏再介入的无事件生存率为 83%。
我们 13 年的 MIDCAB 经验表明，该手术是安全的，并且早期和晚期并发症的发生率非常低。杂交方法在心脏死亡和再次手术的无事件生存率方面提供了极好的长期结果。准确的患者选择以及杂交手术的时机是优化手术和 PCI 结果的必要条件。
