Department of Cardiovascular Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Ann Thorac Surg. 2014 Jul;98(1):23-9. doi: 10.1016/j.athoracsur.2014.03.036. Epub 2014 May 13.
The benefit of adding an internal thoracic artery (ITA) sequential bypass to single or bilateral ITA graft to improve arterial revascularization is not established. The goal of this study is to evaluate the safety and the potential benefit of ITA sequential bypass in coronary artery surgery.
We retrospectively reviewed a cohort of 1,400 consecutive, prospectively followed patients who underwent off-pump coronary artery bypass surgery for multivessel disease between September 1996 and November 2007 at the Montreal Heart Institute. Among them, 1,315 (93.9%) patients had 2- or 3-vessel disease and received at least 1 ITA graft. The following 4 groups were investigated: group 1, single ITA grafting alone (n=758); group 2, single ITA+sequential grafting (n=151); group 3, bilateral ITA grafting alone (n=308); and group 4, bilateral ITA+sequential grafting (n=98).
Mean follow-up was 63±33 months and completed in 97% of the cohort. Single ITA patients were older, had more diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, emergency surgery, and heart failure. The rates of complete revascularization, conversion to cardiopulmonary bypass, perioperative mortality, and myocardial infarction were similar in all groups. After correcting for risk factors, better overall, cardiac, and major adverse cardiac event (MACE)-free survival were observed in the bilateral ITA groups compared with the single ITA groups. Adding sequential ITA bypass grafting did not significantly impact survival or MACE-free survival.
In our series, bilateral ITA grafting improved overall and MACE-free survival. Adding a sequential ITA bypass grafting was safe but did not add significant benefit in off-pump coronary artery bypass surgery.
在改善动脉血运重建方面，将内乳动脉（ITA）序贯旁路移植术加于单支或双侧 ITA 移植术的获益尚未确定。本研究的目的是评估 ITA 序贯旁路移植术在冠状动脉旁路手术中的安全性和潜在获益。
我们回顾性分析了 1996 年 9 月至 2007 年 11 月期间在蒙特利尔心脏研究所接受非体外循环冠状动脉旁路移植术治疗多支血管疾病的 1400 例连续前瞻性随访患者的队列。其中，1315 例（93.9%）患者患有 2 或 3 支血管疾病，并接受了至少 1 支 ITA 移植。以下 4 组进行了研究：组 1，单支 ITA 移植术（n=758）；组 2，单支 ITA+序贯移植术（n=151）；组 3，双侧 ITA 移植术（n=308）；组 4，双侧 ITA+序贯移植术（n=98）。
平均随访时间为 63±33 个月，队列中 97%的患者完成了随访。单支 ITA 患者年龄较大，合并糖尿病、慢性阻塞性肺疾病、外周血管疾病、急诊手术和心力衰竭的比例较高。所有组之间的完全血运重建率、转为体外循环率、围手术期死亡率和心肌梗死率相似。在对危险因素进行校正后，与单支 ITA 组相比，双侧 ITA 组的总体生存率、心脏生存率和主要不良心脏事件（MACE）无事件生存率更好。序贯 ITA 旁路移植术的添加并未显著影响生存率或 MACE 无事件生存率。
在本系列研究中，双侧 ITA 移植术提高了总体生存率和 MACE 无事件生存率。添加序贯 ITA 旁路移植术是安全的，但在非体外循环冠状动脉旁路移植术中并未带来显著获益。
