全胸腔镜冠状动脉旁路移植术后的长期临床及计算机断层扫描血管造影随访
Long-Term Clinical and Computed Tomography Angiographic Follow-up After Totally Endoscopic Coronary Artery Bypass Grafting.
作者信息
Stastny Lukas, Kofler Markus, Dumfarth Julia, Basaran Alim, Wiedemann Dominik, Schachner Thomas, Feuchtner Gudrun, Bonatti Johannes, Bonaros Nikolaos
出版信息
Innovations (Phila). 2018 Jan/Feb;13(1):5-10. doi: 10.1097/IMI.0000000000000461.
OBJECTIVE
Totally endoscopic coronary artery bypass grafting was shown to be feasible and safe, with excellent clinical and angiographic mid-term results. Data on long-term outcome are lacking. Therefore, we aimed to investigate the long-term rate of major adverse cardiac and cerebrovascular events and left internal mammary artery patency rate in patients undergoing arrested heart totally endoscopic coronary artery bypass grafting.
METHODS
From 2001 to 2012, a total of 208 arrested heart-totally endoscopic coronary artery bypass grafting patients were prospectively included. Mean ± SD age was 58.8 ± 9.4 years, and mean ± SD Society of Thoracic Surgeons score was 0.5 ± 0.5%. Major adverse cardiac and cerebrovascular events were defined as a composite of death, myocardial infarction, stroke, re-percutaneous coronary intervention, re-coronary artery bypass graft, and target vessel revascularization. Left internal mammary artery patency was assessed using cardiac computed tomography and depicted according to the established Fitzgibbon classification. Mean ± SD follow-up was 6.9 ± 2.3 years.
RESULTS
At 1, 5, and 10 years, survival rate was 100%, 98.3%, and 95.8%, respectively. The freedom from clinical events at 1, 5, and 10 years were major adverse cardiac and cerebrovascular events (93.5%, 85.9%, and 83.0%), myocardial infarction (99.0%, 97.4%, and 95.9%), target vessel revascularization (96.0%, 94.3%, and 91.7%), re-percutaneous coronary intervention (94.5%, 91.6%, and 84.2%), and re-coronary artery bypass graft (100%, 99.5%, and 99.5%), respectively. Left internal mammary artery patency rate at 1, 5, and 10 years was 100%, 94.9%, and 88.1%, respectively.
CONCLUSIONS
Arrested heart-totally endoscopic coronary artery bypass grafting shows excellent clinical long-term results with a left internal mammary artery patency rate comparable with conventional coronary artery bypass graft at 10 years after surgery.
目的
完全内镜下冠状动脉旁路移植术已被证明是可行且安全的，具有良好的临床和血管造影中期结果。但缺乏长期结果的数据。因此，我们旨在调查接受心脏停搏完全内镜下冠状动脉旁路移植术患者的主要不良心脑血管事件长期发生率和左乳内动脉通畅率。
方法
2001年至2012年，前瞻性纳入了总共208例接受心脏停搏完全内镜下冠状动脉旁路移植术的患者。平均年龄±标准差为58.8±9.4岁，平均胸外科医师协会评分±标准差为0.5±0.5%。主要不良心脑血管事件定义为死亡、心肌梗死、中风、再次经皮冠状动脉介入治疗、再次冠状动脉旁路移植术和靶血管血运重建的综合。使用心脏计算机断层扫描评估左乳内动脉通畅情况，并根据既定的菲茨吉本分类法进行描述。平均随访时间±标准差为6.9±2.3年。
结果
1年、5年和10年时，生存率分别为100%、98.3%和95.8%。1年、5年和10年时无临床事件发生的比例分别为主要不良心脑血管事件（93.5%、85.9%和83.0%）、心肌梗死（99.0%、97.4%和95.9%）、靶血管血运重建（96.0%、94.3%和91.7%）、再次经皮冠状动脉介入治疗（94.5%、91.6%和84.2%）以及再次冠状动脉旁路移植术（100%、99.5%和99.5%）。1年、5年和10年时左乳内动脉通畅率分别为100%、94.9%和88.1%。
结论
心脏停搏完全内镜下冠状动脉旁路移植术显示出良好的长期临床结果，术后10年左乳内动脉通畅率与传统冠状动脉旁路移植术相当。
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