Nishigawa Kosaku, Fukui Toshihiro, Yamazaki Masataka, Takanashi Shuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Ann Thorac Surg. 2017 Mar;103(3):710-716. doi: 10.1016/j.athoracsur.2016.11.028. Epub 2017 Feb 4.
Coronary endarterectomy (CE) is a surgical option for a diffusely diseased coronary artery. This study evaluated the clinical and angiographic outcomes of CE for a diffusely diseased left anterior descending artery (LAD) using the internal thoracic artery (ITA).
From September 2004 to September 2014, 188 patients (163 men; mean age, 66.1 years) underwent coronary artery bypass grafting with CE for a diffusely diseased LAD. Forty patients (21.3%) had unstable angina, and 55 (29.3%) were at Canadian Cardiovascular Society class 3 or 4. Mean ejection fraction was 0.55. Endarterectomy was performed under direct vision through a long arteriotomy in all patients. Angiographic evaluation was performed before discharge and at 1 year after the operation.
Mean arteriotomy length was 6.1 ± 1.8 cm. The endarterectomized LAD was reconstructed using the left ITA in 179 (95.2%) or the right ITA in 9 (4.8%). The operation was conducted off pump in 185 patients (98.4%). The 30-day mortality was 1.1%. Perioperative myocardial infarction occurred in 17 patients (9.0%). The patency rate of the ITA and LAD at early postoperative and follow-up angiography was 91.6% and 96.6%, respectively. Optical coherence tomography performed in 8 patients revealed that the endarterectomized LAD was completely endothelialized and that the surface of the reconstructed lumen had become homogeneous within 1 year after the operation. The median follow-up period was 5.8 years. At 5 years, freedom from all-cause death was 89.3% ± 2.4% and freedom from major adverse cardiac and cerebrovascular events was 74.0% ± 3.3%.
CE for a diffusely diseased LAD using the ITA provides satisfactory clinical outcomes with favorable rates of angiographic patency.
冠状动脉内膜切除术（CE）是弥漫性病变冠状动脉的一种手术选择。本研究评估了使用胸廓内动脉（ITA）对弥漫性病变的左前降支动脉（LAD）进行CE的临床和血管造影结果。
2004年9月至2014年9月，188例患者（163例男性；平均年龄66.1岁）因弥漫性病变的LAD接受了冠状动脉搭桥术联合CE。40例患者（21.3%）患有不稳定型心绞痛，55例（29.3%）为加拿大心血管学会3或4级。平均射血分数为0.55。所有患者均通过长动脉切口在直视下进行内膜切除术。出院前和术后1年进行血管造影评估。
平均动脉切口长度为6.1±1.8cm。179例（95.2%）患者使用左ITA重建内膜切除后的LAD，9例（4.8%）使用右ITA。185例患者（98.4%）在非体外循环下进行手术。30天死亡率为1.1%。17例患者（9.0%）发生围手术期心肌梗死。术后早期和随访血管造影时ITA和LAD的通畅率分别为91.6%和96.6%。对8例患者进行的光学相干断层扫描显示，内膜切除后的LAD在术后1年内完全内皮化，重建管腔表面变得均匀。中位随访期为5.8年。5年时，全因死亡自由度为89.3%±2.4%，主要不良心脑血管事件自由度为74.0%±3.3%。
使用ITA对弥漫性病变的LAD进行CE可提供令人满意的临床结果和良好的血管造影通畅率。
