Yang Ming, Gao Changqing, Liu Shuai, Wu Yang, Xiao Cangsong, Wang Rong
Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Aug;35(8):1166-9.
To assess the short-term outcomes of staged hybrid coronary revascularization performed using robotic-assisted off-pump coronary bypass grafting followed by percutaneous coronary intervention (PCI) in a non-left anterior descending (LAD) coronary artery lesion.
From January, 2007 to May, 2013, 35 patients (32 male and 3 female patients, mean age 56.7 ± 9.6 years) underwent staged hybrid coronary revascularization. Ten patients had double-vessel and 25 patients had triple-vessel coronary diseases, and the lesions involved an average of 2.7 ± 0.5 coronary vessels. Coronary artery bypass grafting was completed in robotic-assisted left internal thoracic artery (ITA) harvesting and LITA to LAD bypass. Coronary angiography or 64-MSCT was performed to evaluate the patency of the ITA and stents at 6 months and at 1 to 5 years postoperatively. The patients were followed for major adverse cardiac events (MACE) including cardiac death, acute myocardial infarction and target lesion revascularization.
Staged hybrid revascularization was completed successfully in all the patients without complications. The LITA to LAD anastomosis was completed in minimally invasive direct coronary bypass grafting (MIDCAB) or totally robotic coronary bypass grafting on beating heart (TECAB) with the assistance of da Vinci Surgical System. The mean artery graft flow was 36.0 ± 22.5 ml/min, and the graft had a 100% patency before discharge. A total of 49 stents were deployed in 35 patients within 2 weeks after robotic coronary bypass grafting, with a mean of 1.34 ± 0.6 stents per case (1 stent in 23 cases, 2 stents in 11 cases, and 3 stents in 1 case). The patients were followed up for 17.5 ± 11.6 months, and 1 patient had artery graft occlusion and another had in-stent occlusion at 6 months. All the other 33 patients had patent LITA-to-LAD anastomosis without angina or MACE.
Staged hybrid revascularization strategy has acceptable angiographic patency results for both LITA-LAD grafts and PCI interventions.
评估在非左前降支（LAD）冠状动脉病变中，采用机器人辅助非体外循环冠状动脉旁路移植术，随后进行经皮冠状动脉介入治疗（PCI）的分期杂交冠状动脉血运重建的短期疗效。
2007年1月至2013年5月，35例患者（32例男性，3例女性，平均年龄56.7±9.6岁）接受了分期杂交冠状动脉血运重建。10例患者为双支血管病变，25例患者为三支血管病变，病变平均累及2.7±0.5支冠状动脉血管。冠状动脉旁路移植术通过机器人辅助左乳内动脉（ITA）采集和左乳内动脉至左前降支旁路移植完成。术后6个月以及术后1至5年进行冠状动脉造影或64排多层螺旋CT检查，以评估ITA和支架的通畅情况。对患者进行主要不良心脏事件（MACE）随访，包括心源性死亡、急性心肌梗死和靶病变血运重建。
所有患者均成功完成分期杂交血运重建，无并发症发生。在达芬奇手术系统的辅助下，通过微创直接冠状动脉旁路移植术（MIDCAB）或完全机器人辅助心脏跳动下冠状动脉旁路移植术（TECAB）完成了左乳内动脉至左前降支的吻合。平均动脉桥血流量为36.0±22.5 ml/min，出院前移植血管通畅率为100%。35例患者在机器人辅助冠状动脉旁路移植术后2周内共植入49枚支架，平均每例1.34±0.6枚支架（23例植入1枚支架，11例植入2枚支架，1例植入3枚支架）。患者随访17.5±11.6个月，6个月时1例患者移植血管闭塞，另1例患者支架内闭塞。其余33例患者左乳内动脉至左前降支吻合口通畅，无心绞痛或MACE发生。
分期杂交血运重建策略对于左乳内动脉至左前降支移植血管和PCI干预均具有可接受的血管造影通畅结果。
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