Ji Qiang, Xia LiMin, Shi YunQing, Ma RunHua, Shen JinQiang, Lai Hao, Ding WenJun, Wang ChunSheng
Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University.
Shanghai Institute of Cardiovascular Disease.
Int Heart J. 2018 Jan 27;59(1):35-42. doi: 10.1536/ihj.16-554. Epub 2017 Dec 27.
This study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The mid-term survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.
本研究旨在评估原位骨骼化右乳内动脉（IMA）至左前降支动脉（LAD）搭桥术的可行性和中期疗效，并在一项单中心研究中确定IMA移植失败的危险因素。2012年1月至2015年12月，189例患者（173例男性，年龄50.6±6.0岁）接受了首次单纯冠状动脉搭桥手术，采用原位骨骼化右IMA至LAD搭桥，纳入本研究。对基线特征、手术数据和随访结果进行了调查和分析。原位骨骼化右IMA移植物的长度为18.6±1.2 cm（17.0 - 22.0 cm）。原位骨骼化右IMA至LAD搭桥术中移植物血流为42±9 mL/分钟（18 - 72 mL/分钟），测得的搏动指数为0.8 - 4.3。住院死亡率为0.5%。术后并发症包括急性心肌梗死（0.5%）、中风（0.5%）和深部胸骨伤口感染（1.1%）。中期生存率为97.2%，再次血运重建发生率为0.6%。在23.2±9.7个月的随访期内，通过计算机断层扫描血管造影检查，原位骨骼化右IMA至LAD搭桥的通畅率为97.1%。此外，逻辑回归分析表明，术中移植物血流对中期右IMA移植失败风险有独立影响。原位骨骼化右IMA至LAD搭桥策略是可行且有效的。术中移植物血流是中期右IMA移植失败的独立危险因素。
