Rastan Ardawan J
Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum Rotenburg, Rotenburg, Germany.
Thorac Cardiovasc Surg. 2017 Apr;65(S 03):S167-S173. doi: 10.1055/s-0037-1601375. Epub 2017 Apr 7.
Friedrich Wilhelm Mohr from the very beginning of his career as a cardiac surgeon was involved in the refinements of coronary artery bypass grafting (CABG). At the Leipzig Heart Center, his spirit of early adapting to new technologies inspired the entire team and led to a matchless scientific atmosphere to find solutions to improve almost all fields of cardiac surgery, including CABG. In combination with a tremendous number of patients with indications for isolated coronary artery bypass Prof. Mohr as the surgical principle investigator and the Leipzig Heart Center were able to include patients in the Synergy between PCI [percutaneous coronary intervention] with Taxus and Cardiac Surgery (SYNTAX) trial, the first randomized trials comparing CABG and PCIs using the drug-eluting stents. Final SYNTAX results after 5 years gave direction and scientific evidence for contemporary European revascularization guidelines. These guidelines recommend PCI as an alternative first-line treatment option in patients with coronary three-vessel disease and left main stenosis having low coronary complexity based on the angiographic SYNTAX score. However, the study demonstrated the significant superiority of CABG over PCI in all other patients, especially in these with complex three-vessel disease. The specific characteristic of the SYNTAX study is that the distinguished results were confirmed by several post-SYNTAX comparative randomized trials on coronary revascularization including left main disease and clinical registries even when contemporary drug-eluting stent designs were used. When performing CABG the question of the best second graft remains unclear. While several mono-institutional reports and large meta-analyses demonstrated clear superiority in terms of long-term survival when using bilateral mammary versus single mammary revascularization, this benefit could not be confirmed in randomized trials after 5 years.
弗里德里希·威廉·莫尔从其成为心脏外科医生职业生涯的一开始，就参与了冠状动脉搭桥术（CABG）的改进工作。在莱比锡心脏中心，他早期适应新技术的精神激励了整个团队，并营造了无与伦比的科学氛围，以找到改善心脏外科几乎所有领域（包括CABG）的解决方案。莫尔教授作为手术主要研究者，与莱比锡心脏中心一起，面对大量有单纯冠状动脉搭桥术指征的患者，得以将患者纳入“紫杉醇药物洗脱支架经皮冠状动脉介入治疗（PCI）与心脏外科手术协同研究（SYNTAX）试验”，这是首个比较CABG和使用药物洗脱支架的PCI的随机试验。5年后的SYNTAX最终结果为当代欧洲血运重建指南提供了方向和科学依据。这些指南推荐，对于基于血管造影SYNTAX评分显示冠状动脉复杂性低的冠状动脉三支病变和左主干狭窄患者，PCI可作为替代的一线治疗选择。然而，该研究表明，在所有其他患者中，尤其是在患有复杂三支病变的患者中，CABG明显优于PCI。SYNTAX研究的独特之处在于，即使使用当代药物洗脱支架设计，该研究得出的卓越结果也在多项SYNTAX之后关于包括左主干疾病在内的冠状动脉血运重建的比较随机试验以及临床注册研究中得到了证实。在进行CABG时，最佳的第二条移植血管的问题仍不明确。虽然一些单机构报告和大型荟萃分析表明，在长期生存方面，使用双侧乳腺血管进行血运重建比单乳腺血管血运重建具有明显优势，但5年后的随机试验未能证实这一益处。
