Nagendran Jeevan, Tarola Chris, Catrip Jorge, Fox Stephanie A, Chu Michael W A, Teefy Patrick, Sridhar Kumar, Diamantouros Pantelis, Kiaii Bob
Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, ON, Canada.
J Clin Med Res. 2018 Aug;10(8):626-629. doi: 10.14740/jocmr3399w. Epub 2018 Jun 27.
The efficacy of diagonal coronary artery stenting in patients undergoing robotic left internal thoracic artery-to-left anterior descending (LITA-to-LAD) anastomosis is not well defined. The objective of this study was to assess graft and stent patency in a single-stage hybrid revascularization with LITA-to-LAD anastomosis and PCI to a diagonal coronary artery.
From 2004 to 2014, a total of 25 patients consented to robotic-assisted LITA harvesting and a small left anterior thoracotomy for off-pump coronary artery bypass anastomosis onto the LAD along with concomitant PCI to the diagonal coronary artery. PCI to the diagonal coronary artery was performed in the same fluoroscopy-equipped hybrid operating room.
Patients were on average 66 ± 11 years with 32% female. Pre-operative characteristics of these patients included 8% with a grade 3 or 4 left ventricle, 16% with a recent MI, and 92% with CCS III/IV symptoms. There were no death, one patient required an intra-aortic balloon pump, and one patient required re-operation for bleeding. The average ICU stay was 1.1 ± 0.53 days, and the average hospital stay was 4.6 ± 2.4 days. Fitzgibbon Grade A LITA-to-LAD patency at 6-month follow-up was 100%. As well, at 6-month follow-up the DES to the diagonal coronary artery had a patency rate of 96%.
Single-stage hybrid revascularization strategy for bifurcating lesions of the LAD and diagonal coronary arteries with LITA-to-LAD anastomosis and PCI to a diagonal coronary artery appears to have acceptable clinical results with excellent 6-month angiographic patency results.
机器人辅助下左乳内动脉至左前降支（LITA - to - LAD）吻合术患者中行对角冠状动脉支架置入术的疗效尚不明确。本研究的目的是评估在LITA - to - LAD吻合术和对角冠状动脉PCI的单阶段杂交血运重建术中移植物和支架的通畅情况。
2004年至2014年，共有25例患者同意接受机器人辅助下LITA采集及左前胸部小切口非体外循环冠状动脉旁路移植术，将其吻合至LAD，同时对对角冠状动脉进行PCI。对角冠状动脉的PCI在同一配备透视设备的杂交手术室进行。
患者平均年龄66±11岁，女性占32%。这些患者的术前特征包括8%为左心室3级或4级，16%近期发生心肌梗死，92%有CCS III/IV级症状。无死亡病例，1例患者需要主动脉内球囊反搏，1例患者因出血需要再次手术。平均ICU住院时间为1.1±0.53天，平均住院时间为4.6±2.4天。6个月随访时，Fitzgibbon A级LITA - to - LAD通畅率为100%。同样，6个月随访时，对角冠状动脉DES通畅率为96%。
对于LAD和对角冠状动脉分叉病变采用LITA - to - LAD吻合术和对角冠状动脉PCI的单阶段杂交血运重建策略似乎具有可接受的临床结果，6个月血管造影通畅结果良好。
