Shen J Q, Ji Q, Ding W J, Xia L M, Wei L, Wang C S
Department of Cardiovascular Surgery, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2018 Mar 13;98(10):763-767. doi: 10.3760/cma.j.issn.0376-2491.2018.10.010.
To evaluate in-hospital and mid-term outcomes of sequential versus separate grafting of in situ skeletonized left internal mammary artery (LIMA) to the left coronary system in a single-center, propensity-matched study. After propensity score matching, 120 pairs of patients undergoing first, scheduled, isolated coronary artery bypass grafting (CABG) with in situ skeletonized LIMA grafting to the left anterior descending artery (LAD) territory were entered into a sequential group (sequential grafting of LIMA to the diagonal artery and then to the LAD) or a control group (separate grafting of LIMA to the LAD). The in-hospital and follow-up clinical outcomes and follow-up LIMA graft patency were compared. The two propensity score-matched groups had similar in-hospital and follow-up clinical outcomes. The number of bypass conduits ranged from 3 to 6 (with a mean of 3.5), and 91.3%(219/240)of the included patients received off-pump CABG surgery. No significant differences were found between the two propensity score-matched groups in the in-hospital outcomes, including in-hospital death and the incidence of complications associated with CABG (prolonged ventilation, peroperative stroke, re-operation before discharge, and deep sternal wound infection). During follow-up, 9 patients (4 patients from the sequential group and 5 patients from the control group) died, and the all-cause mortality rate was 3.9%. No significant difference was found in the all-cause mortality rate between the 2 groups[3.4% (4/116) vs 4.3% (5/115), =0.748]. During follow-up period, 99.1% (115/116) patency for the diagonal site and 98.3% (114/116) for the LAD site were determined by coronary computed tomographic angiography after sequential LIMA grafting, both of which were similar with graft patency of separate grafting of in situ skeletonized LIMA to the LAD. Revascularization of the left coronary system using a skeletonized LIMA resulted in excellent in-hospital and mid-term clinical outcomes and graft patency using sequential grafting.
在一项单中心倾向评分匹配研究中，评估序贯式与单独式原位骨骼化左乳内动脉（LIMA）移植至左冠状动脉系统的院内及中期结局。经过倾向评分匹配后，120对接受首次、计划性、单纯冠状动脉旁路移植术（CABG）且将原位骨骼化LIMA移植至左前降支动脉（LAD）区域的患者被纳入序贯组（LIMA先移植至对角支动脉，然后再移植至LAD）或对照组（LIMA单独移植至LAD）。比较两组的院内及随访临床结局以及随访期间LIMA移植血管的通畅情况。倾向评分匹配的两组患者具有相似的院内及随访临床结局。旁路血管数量为3至6根（平均3.5根），91.3%（219/240）的纳入患者接受了非体外循环CABG手术。倾向评分匹配的两组在院内结局方面无显著差异，包括院内死亡以及与CABG相关的并发症发生率（通气时间延长、术中卒中、出院前再次手术以及胸骨深部伤口感染）。随访期间，9例患者（序贯组4例，对照组5例）死亡，全因死亡率为3.9%。两组的全因死亡率无显著差异[3.4%（4/116）对4.3%（5/115），P = 0.748]。随访期间，序贯式LIMA移植后通过冠状动脉计算机断层血管造影术测定对角支部位的通畅率为99.1%（115/116），LAD部位为98.3%（114/116），两者均与原位骨骼化LIMA单独移植至LAD的移植血管通畅情况相似。使用骨骼化LIMA对左冠状动脉系统进行血运重建，采用序贯式移植可带来良好的院内及中期临床结局以及移植血管通畅率。
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