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在经皮冠状动脉介入治疗(PCI)时代,冠状动脉外科医生保持“竞争力与合作精神”的策略。

Strategies for the coronary surgeon to remain "competitive and co-operative" in the PCI era.

作者信息

Valooran George Jose, Nair Shiv Kumar, Chandrasekharan Krishnan

机构信息

Consultant, Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, India.

Senior Consultant and HOD, Department of Cardiovascular and Thoracic Surgery, Rajagiri Hospital, India.

出版信息

Indian Heart J. 2015 Jul-Aug;67(4):351-8. doi: 10.1016/j.ihj.2015.05.002. Epub 2015 Jul 8.

DOI:10.1016/j.ihj.2015.05.002
PMID:26304568
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4561793/
Abstract

BACKGROUND

The advent of percutaneous intervention has made surgical treatment of coronary artery disease less favored by patients though the evidence that supports CABG in certain patient subsets is strong.

METHODS

Literature review was done using Pubmed, Scopus, Google and Google Scholar with MeSH terms-coronary artery bypass grafting, internal mammary artery, drug eluting stent, stroke, myocardial revascularization.

RESULTS

The adoption of evolving techniques like anaortic off pump grafting, bilateral internal mammary artery use, hybrid and minimally invasive coronary revascularization techniques, intra-operative graft assessment, and heart team approach can lead to better outcomes following surgery as is evidenced by recent literature.

CONCLUSIONS

Though the adoptability of the newer strategies may vary between centers a close coalition between coronary surgeons and cardiologists would ensure that the management of coronary artery disease is based on evidence for the benefit of the patient.

摘要

背景

尽管有充分证据表明在某些患者亚组中行冠状动脉旁路移植术(CABG)有益,但经皮介入治疗的出现使冠心病的外科治疗不太受患者青睐。

方法

使用PubMed、Scopus、谷歌和谷歌学术进行文献综述,检索词为——冠状动脉旁路移植术、乳内动脉、药物洗脱支架、中风、心肌血运重建。

结果

采用诸如非体外循环冠状动脉搭桥术、双侧乳内动脉的使用、杂交及微创冠状动脉血运重建技术、术中移植物评估以及心脏团队模式等不断发展的技术,可使术后获得更好的结果,近期文献已证实这一点。

结论

尽管各中心对新策略的采用情况可能有所不同,但冠状动脉外科医生和心脏病专家之间的紧密合作将确保基于证据对冠心病进行管理,以造福患者。

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本文引用的文献

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Off-pump no-touch technique: 3-year results compared with the SYNTAX trial.非体外循环非接触技术:与SYNTAX试验相比的3年结果
Interact Cardiovasc Thorac Surg. 2015 May;20(5):601-4. doi: 10.1093/icvts/ivv012. Epub 2015 Feb 7.
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Minimally invasive coronary bypass using internal thoracic arteries via a left minithoracotomy: "the Nambiar Technique".经左胸小切口使用胸廓内动脉进行微创冠状动脉搭桥术:“南比亚尔技术”
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Intraoperative graft verification in coronary surgery: increased diagnostic accuracy adding high-resolution epicardial ultrasonography to transit-time flow measurement.冠状动脉手术中的术中移植物验证:将高分辨率心外膜超声检查添加到通过时间流量测量中可提高诊断准确性。
Eur J Cardiothorac Surg. 2014 Mar;45(3):e41-5. doi: 10.1093/ejcts/ezt580. Epub 2013 Dec 12.
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Clinical and angiographic results after hybrid coronary revascularization.杂交冠状动脉血运重建术后的临床和血管造影结果。
Ann Thorac Surg. 2014 Feb;97(2):484-90. doi: 10.1016/j.athoracsur.2013.08.041. Epub 2013 Oct 17.
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Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects.冠状动脉旁路移植术:第 2 部分——优化结果和未来前景。
Eur Heart J. 2013 Oct;34(37):2873-86. doi: 10.1093/eurheartj/eht284.
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Total arterial coronary revascularization-patient selection, stenoses, conduits, targets.全动脉化冠状动脉血运重建-患者选择、狭窄病变、桥血管、靶血管。
Ann Cardiothorac Surg. 2013 Jul;2(4):499-506. doi: 10.3978/j.issn.2225-319X.2013.07.02.
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Importance of the third arterial graft in multiple arterial grafting strategies.三支动脉桥在多支动脉搭桥策略中的重要性。
Ann Cardiothorac Surg. 2013 Jul;2(4):475-80. doi: 10.3978/j.issn.2225-319X.2013.07.01.
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A meta-analysis comparing bilateral internal mammary artery with left internal mammary artery for coronary artery bypass grafting.双侧内乳动脉与左内乳动脉在冠状动脉旁路移植术中的对比的荟萃分析。
Ann Cardiothorac Surg. 2013 Jul;2(4):390-400. doi: 10.3978/j.issn.2225-319X.2013.07.16.
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Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II.解剖学和临床特征指导个体患者冠状动脉旁路移植术与经皮冠状动脉介入治疗决策:SYNTAX 评分 II 的制定和验证。
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