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杂交冠状动脉血运重建术作为传统冠状动脉旁路移植术的一种安全、可行且有效的替代方案:当前证据有哪些?

Hybrid coronary revascularization as a safe, feasible, and viable alternative to conventional coronary artery bypass grafting: what is the current evidence?

作者信息

Verhaegh Arjan J F P, Accord Ryan E, van Garsse Leen, Maessen Jos G

机构信息

Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.

出版信息

Minim Invasive Surg. 2013;2013:142616. doi: 10.1155/2013/142616. Epub 2013 Apr 3.

Abstract

The "hybrid" approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between 93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC) transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population.

摘要

多支冠状动脉疾病的“杂交”治疗方法是将外科手术的左内乳动脉(LITA)至左前降支冠状动脉(LAD)搭桥术与对其余病变进行经皮冠状动脉介入治疗相结合。理想情况下,LITA至LAD搭桥术以微创方式进行。本综述旨在阐明杂交冠状动脉血运重建术(HCR)在当前针对多支冠状动脉疾病的治疗手段中的地位。纳入18项研究共970例患者进行分析。术后LITA通畅率在93.0%至100.0%之间。接受杂交治疗患者的平均总生存率为98.1%。与接受体外循环和非体外循环冠状动脉搭桥术(CABG)治疗的患者相比,接受杂交治疗的患者在统计学上显示出住院时间(LOS)、重症监护病房(ICU)住院时间和插管时间显著缩短,浓缩红细胞(PRBC)输注需求减少,院内主要不良心脑血管事件(MACCE)发生率降低。这导致杂交治疗患者术后成本显著降低。在迄今为止完成的研究中,对于特定患者群体,HCR似乎是治疗多支冠状动脉疾病时CABG的一种有前景且具有成本效益的替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50f9/3649801/c5df22050b55/MIS2013-142616.001.jpg

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