Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Ill.
Section of Cardiology, Department of Medicine, The University of Chicago Medicine, Chicago, Ill.
J Thorac Cardiovasc Surg. 2019 May;157(5):1829-1836.e1. doi: 10.1016/j.jtcvs.2018.08.126. Epub 2018 Nov 14.
The purpose of this study was to investigate the outcomes of patients undergoing advanced hybrid coronary revascularization, defined as robotic beating-heart multivessel totally endoscopic coronary artery bypass combined with percutaneous coronary intervention.
This is a retrospective study. Among 308 consecutive patients who underwent totally endoscopic coronary artery bypass, 57 who underwent advanced hybrid coronary revascularization (mean age, 65.6 years) from July 2013 to September 2017 were included. Midterm survival and freedom from major adverse cardiac events, including death, myocardial infarction, and repeat revascularization, were analyzed.
Multivessel totally endoscopic coronary artery bypass was successfully performed without conversion to thoracotomy. Bilateral internal thoracic artery grafting was used in 50 patients (87.7%). The mean operative time was 318.4 ± 51.0 minutes. The mean length of hospital stay was 3.0 ± 1.3 days. There was no 30-day mortality. Percutaneous coronary intervention was planned after totally endoscopic coronary artery bypass in 51 patients (89.4%). The target lesions were the right coronary artery only in 38 patients, the left circumflex artery only in 4 patients, and multiple lesions in 13 patients. Eventually, 2 patients did not receive percutaneous coronary intervention. Percutaneous coronary intervention attempt was unsuccessful in 8 lesions. Patency of the left/right internal thoracic artery was 95.2% (60/63) and 95.7% (45/47), respectively. Graft patency was 95.2% (40/42) in the left circumflex artery and 93.3% (14/15) in the diagonal branch. Three-year survival was 92.8%, and 3-year freedom from major adverse cardiac events was 80.2%.
Advanced hybrid coronary revascularization is a safe and less-invasive approach with short hospital stay and good midterm outcomes.
本研究旨在探讨定义为机器人心脏不停跳多支血管全内镜冠状动脉旁路移植术联合经皮冠状动脉介入治疗的患者的临床结局。
这是一项回顾性研究。在 308 例连续接受全内镜冠状动脉旁路移植术的患者中，2013 年 7 月至 2017 年 9 月期间有 57 例（平均年龄 65.6 岁）接受了高级杂交冠状动脉血运重建术。分析了中期生存率和免于主要不良心脏事件（包括死亡、心肌梗死和再次血运重建）的情况。
多支血管全内镜冠状动脉旁路移植术均成功实施，无中转开胸。50 例（87.7%）患者行双侧内乳动脉搭桥。手术时间平均为 318.4±51.0 分钟。平均住院时间为 3.0±1.3 天。无 30 天死亡率。51 例（89.4%）患者在全内镜冠状动脉旁路移植术后计划行经皮冠状动脉介入治疗。仅右冠状动脉病变 38 例，仅左回旋支病变 4 例，多支病变 13 例。最终有 2 例未行经皮冠状动脉介入治疗。8 个病变经皮冠状动脉介入治疗尝试不成功。左/右内乳动脉通畅率分别为 95.2%（60/63）和 95.7%（45/47）。左回旋支旁路移植血管通畅率为 95.2%（40/42），对角支旁路移植血管通畅率为 93.3%（14/15）。3 年生存率为 92.8%，3 年免于主要不良心脏事件发生率为 80.2%。
高级杂交冠状动脉血运重建术是一种安全、微创的方法，具有住院时间短和良好的中期结果。
