Itoh Satoshi, Kimura Naoyuki, Adachi Hideo, Yamaguchi Atsushi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University.
Circ J. 2016 Jul 25;80(8):1756-63. doi: 10.1253/circj.CJ-16-0181. Epub 2016 Jun 23.
Although bilateral internal mammary artery (BIMA) grafting is performed with increasing regularity in elderly patients, whether it is truly beneficial, and therefore indicated, in these patients remains uncertain. We retrospectively investigated early and late outcomes of BIMA grafting in patients aged ≥75 years.
We identified 460 patients aged ≥75 years from among 2,618 patients who underwent either single internal mammary artery (SIMA) grafting (n=293) or BIMA grafting (n=107). Early outcomes did not differ between the SIMA and BIMA patients (30-day mortality: 1.7% vs. 0%, P=0.39; sternal wound infection: 1.0% vs. 4.7%; P=0.057). Late outcomes, 10-year survival in particular, were improved in the BIMA group (36.6% vs. 48.1%, P=0.033). In the analysis of the results in propensity score-matched groups (196 patients in the SIMA group, 98 patients in the BIMA group), improved 10-year survival was documented in the BIMA group (34.8% vs. 47.6%, P=0.030). Cox proportional regression analysis showed SIMA usage (non-use of BIMA) to be a predictor for late mortality (hazard ratio: 0.65, 95% confidence interval: 0.43-0.98, P=0.042). We further compared outcomes between the total non-elderly patients (n=2,158) and total elderly patients (n=460). BIMA usage was similar, as was 30-day mortality (1.0% vs. 1.3%, respectively).
A survival advantage, with no increase in early mortality, can be expected from BIMA grafting in patients aged ≥75 years. (Circ J 2016; 80: 1756-1763).
尽管双侧乳内动脉（BIMA）移植术在老年患者中的应用越来越普遍，但在这些患者中它是否真的有益，以及是否因此而适用，仍不确定。我们回顾性研究了年龄≥75岁患者行BIMA移植术的早期和晚期结果。
我们从2618例行单乳内动脉（SIMA）移植术（n = 293）或BIMA移植术（n = 107）的患者中识别出460例年龄≥75岁的患者。SIMA组和BIMA组患者的早期结果无差异（30天死亡率：1.7%对0%，P = 0.39；胸骨伤口感染：1.0%对4.7%；P = 0.057）。晚期结果，尤其是10年生存率，在BIMA组有所改善（36.6%对48.1%，P = 0.033）。在倾向评分匹配组（SIMA组196例患者，BIMA组98例患者）的结果分析中，BIMA组的10年生存率有所提高（34.8%对47.6%，P = 0.030）。Cox比例回归分析显示使用SIMA（未使用BIMA）是晚期死亡的一个预测因素（风险比：0.65，95%置信区间：0.43 - 0.98，P = 0.042）。我们进一步比较了所有非老年患者（n = 2158）和所有老年患者（n = 460）的结果。BIMA的使用情况相似，30天死亡率也相似（分别为1.0%和1.3%）。
年龄≥75岁的患者行BIMA移植术可预期有生存优势，且早期死亡率无增加。（《循环杂志》2016年；80：1756 - 1763）
