Perrotti Andrea, Spina Amedeo, Dorigo Enrica, Durst Camille, Kaili Djamel, Chocron Sidney
Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Besancon Ringgold Standard Institution, Besancon, France.
Thorac Cardiovasc Surg. 2017 Jun;65(4):265-271. doi: 10.1055/s-0036-1584688. Epub 2016 Jul 1.
Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a < 0.3 at univariate analysis. Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3-9.9 and OR: 5.4, 95% CI: 1.3-21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control ( = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2-33.5), that was unfailingly due to ungraftable right coronary artery targets. BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.
采用双侧胸廓内动脉（BITA）的多支冠状动脉旁路移植术（CABG）一直都不常见且技术要求高。我们描述了仅使用BITA且需要≥4个吻合口的CABG的经验。查询该科室数据库中接受孤立性CABG且吻合口≥4个的患者。手术技术系统地包括左胸廓内动脉（ITA）Y型移植的右胸廓内动脉。多变量模型纳入了单变量分析时P<0.3的变量。2006年1月至2009年12月期间，251例连续患者（71±10岁）（体外循环：130例，非体外循环：121例）接受了吻合口≥4个的CABG，占同期孤立性CABG总数的21%；所有患者均接受了仅采用全动脉化BITA的血运重建。随访时间为4.9±1.6年。5年时总体累积生存率和心脏累积生存率分别为78%和92%。任何术后主要并发症的发生均与总体死亡率和心脏死亡率相关（优势比[OR]：3.6，95%置信区间[CI]：1.3 - 9.9；OR：5.4，95%CI：1.3 - 21.9）。需要手术翻修的主要胸骨伤口并发症与血糖控制受损无关（P = 0.06；糖尿病患者：6/82，7.3%；非糖尿病患者：3/169，1.8%）。术前肾衰竭与血运重建不完全相关（OR：6.2；95%CI：1.2 - 33.5），这无一例外是由于右冠状动脉靶血管无法进行移植。仅采用BITA的血运重建是一种有价值且安全的手术，在5年随访时的发病率和死亡率方面结果良好。
