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不完全血运重建:外科医生需要了解的内容。

Incomplete revascularization: what the surgeon needs to know.

作者信息

Leviner Dror B, Torregrossa Gianluca, Puskas John D

机构信息

Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

出版信息

Ann Cardiothorac Surg. 2018 Jul;7(4):463-469. doi: 10.21037/acs.2018.06.07.

Abstract

For many years, the concept of "complete revascularization" (CR) was considered an absolute truth in coronary surgery with improved long-term survival and a lower rate of reintervention. This was derived from early publications which showed a survival benefit for patients undergoing coronary artery bypass grafting (CABG) who received CR. Many advances in the field of coronary revascularization have been made in the years that passed since those publications, including more frequent use of percutaneous coronary intervention (PCI) in patients with multivessel disease (MVD). This has led some to question the importance of CR and raise the option of "reasonable incomplete revascularization" (IR) for selected patients. The definition of CR is variable in the literature with the two most common definitions being an anatomical (revascularization of all coronary segments with stenosis and larger than a predefined size) and a functional definition (where revascularization is considered complete if all ischemic and viable territories are reperfused). No randomized control trials have been conducted to compare complete versus IR, and a significant proportion of data is based on post hoc analysis of data from randomized control trials and registries. Multiple studies have proven that CR is achieved more frequently with CABG then with PCI. A review of the available data from the past three to four decades shows a trend toward improved results with CR, regardless of the reperfusion strategy chosen. This should impact the heart team discussion when choosing a revascularization strategy and impact the surgical decision making while preforming CABG. IR can be part of a hybrid revascularization strategy or be reserved for rare cases where the cost of achieving CR much outweighs the benefit.

摘要

多年来,“完全血运重建”(CR)的概念在冠状动脉手术中被视为绝对真理,认为其能提高长期生存率并降低再次干预率。这一概念源于早期的出版物,这些出版物显示接受CR的冠状动脉旁路移植术(CABG)患者有生存获益。自这些出版物发表后的数年里,冠状动脉血运重建领域取得了许多进展,包括在多支血管疾病(MVD)患者中更频繁地使用经皮冠状动脉介入治疗(PCI)。这使得一些人质疑CR的重要性,并提出了针对特定患者的“合理不完全血运重建”(IR)选项。CR的定义在文献中并不统一,最常见的两种定义是解剖学定义(对所有狭窄且大于预定义尺寸的冠状动脉节段进行血运重建)和功能定义(如果所有缺血和存活区域均得到再灌注,则认为血运重建完成)。目前尚未进行随机对照试验来比较完全血运重建与不完全血运重建,且相当一部分数据基于对随机对照试验和登记处数据的事后分析。多项研究已证明,CABG比PCI更常实现CR。对过去三四十年的现有数据进行回顾显示,无论选择何种再灌注策略,CR都有改善结果的趋势。这应会影响心脏团队在选择血运重建策略时的讨论,并影响进行CABG时的手术决策。IR可以是混合血运重建策略的一部分,或者留用于实现CR的成本远超过获益的罕见情况。

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5
Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting.
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8
Effect of complete revascularization on 10-year survival of patients with stable multivessel coronary artery disease: MASS II trial.
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