Raffa Giuseppe M, Malvindi Pietro G, Ornaghi Diego, Citterio Enrico, Cappai Antioco, Basciu Alessio, Barbone Alessandro, Fossati Francesca, Tarelli Giuseppe, Settepani Fabrizio
Unit of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2015 Feb;16(2):118-24. doi: 10.2459/JCM.0b013e3283630c60.
Minimally invasive coronary artery bypass (MIDCAB) allows revascularization of the left anterior descending coronary (LAD) artery through a less traumatic surgical approach. However, the procedure is technically challenging and concern still exists, mainly based on graft patency. The purpose of this study is to critically evaluate short and long-term benefits of this surgical treatment.
Between June 1997 and July 2012, 306 patients underwent MIDCAB on LAD. The mean age was 62 ± 10 years (range, 32-87 years) and 264 patients (86.3%) were men. Mean ejection fraction was 54%. Eighty-nine procedures (29.1%) were performed using a hybrid approach by means of MIDCAB and postoperative (60 patients, 67.4%) or preoperative (29 patients, 32.6%) percutaneous interventions on non-LAD vessels. A EuroScore more than 6 was found in 43 (14%) patients. The average follow-up time was 9.5 ± 3.2 years and was 89% complete.
Six patients (1.9%) required intraoperative conversion to sternotomy, whereas cardiopulmonary bypass institution after the sternotomy was necessary in one. Postoperative acute myocardial infarction occurring nine patients (2.9%), low output syndrome in four (1.3%). Postoperative mortality was 1.6% (n = 5), and perioperative stroke rate 0.6% (n = 2). Five and 10-year survival were 94.1 and 86.9%, respectively. Freedom from death due to cardiac events and major cardiac and cerebral events at 10 years was, respectively, 97.1 and 92.1%.
The results confirm the favorable short and long-term results of the MIDCAB procedure. MIDCAB, in experienced centers, can represent an alternative treatment option for LAD disease.
微创冠状动脉搭桥术（MIDCAB）可通过创伤较小的手术方式实现左前降支冠状动脉（LAD）血管重建。然而，该手术在技术上具有挑战性，且主要基于移植物通畅性，相关担忧依然存在。本研究的目的是严格评估这种外科治疗的短期和长期益处。
1997年6月至2012年7月期间，306例患者接受了LAD的MIDCAB手术。平均年龄为62±10岁（范围32 - 87岁），264例患者（86.3%）为男性。平均射血分数为54%。89例手术（29.1%）采用了混合方法，即通过MIDCAB以及对非LAD血管进行术后（60例患者，67.4%）或术前（29例患者，32.6%）经皮介入治疗。43例（14%）患者的欧洲心脏手术风险评估系统（EuroScore）评分超过6分。平均随访时间为9.5±3.2年，随访完成率为89%。
6例患者（1.9%）术中需要转为胸骨切开术，而其中1例在胸骨切开术后需要建立体外循环。术后9例患者（2.9%）发生急性心肌梗死，4例（1.3%）发生低心排血量综合征。术后死亡率为1.6%（n = 5），围手术期卒中发生率为0.6%（n = 2）。5年和10年生存率分别为94.1%和86.9%。10年时无心脏事件死亡以及无重大心脏和脑血管事件的生存率分别为97.1%和92.1%。
结果证实了MIDCAB手术良好的短期和长期效果。在经验丰富的中心，MIDCAB可作为LAD疾病的一种替代治疗选择。
