微创冠状动脉旁路移植术：20 年经验。

Minimally invasive coronary artery bypass: Twenty-year experience.

机构信息

Department of Cardiac Surgery, University of Brescia, Brescia, Italy.

出版信息

J Thorac Cardiovasc Surg. 2019 Jul;158(1):127-138.e1. doi: 10.1016/j.jtcvs.2018.11.149. Epub 2018 Dec 29.

DOI:10.1016/j.jtcvs.2018.11.149

PMID:30739774

Abstract

OBJECTIVE

Minimally invasive direct coronary artery bypass for the left thoracic artery on the left anterior descending artery is a safe and less traumatic surgical technique. We retrospectively evaluated long-term outcomes in a large series of patients undergoing minimally invasive direct coronary artery bypass.

METHODS

From 1997 to 2016, 1060 patients underwent minimally invasive direct coronary artery bypass: 646 patients (61%) with isolated proximal left anterior descending disease and 414 patients (39%) with multivessel disease as a part of hybrid coronary revascularization or in association with medical therapy. Long-term follow-up, major cardiac and cerebral adverse events, and freedom from angina were analyzed.

RESULTS

Mean age of patients was 71 ± 12.5 years, and median European System for Cardiac Operative Risk Evaluation II was 3.2% (interquartile range, 0.6%-7.8%). Postoperative death occurred in 9 patients (0.8%), and perioperative stroke occurred in 3 patients (0.3%). An angiogram or computed tomography scan was performed and was available in patients within 10 years of follow-up (n = 696), demonstrating a 96.8% graft patency rate. At 13.9 ± 5.6 years of follow-up, no surgical reintervention was performed for left thoracic artery on left anterior descending artery graft failure, but 14 patients underwent left anterior descending or left thoracic artery on left anterior descending artery percutaneous coronary intervention. Kaplan-Meier survival curve shows 87.1% at 5 years (95% confidence interval, 81-92.5), 84.3% at 10 years (95% confidence interval, 77.1-91.4), and 79.8% at 15 years (95% confidence interval, 72.2-87.3). Survival freedom from major adverse events was 87.0% (95% confidence interval, 85.9-88.1) at 5 years and 70.5% (95% confidence interval, 66.4-74.6) at 15 years.

CONCLUSIONS

Minimally invasive direct coronary artery bypass can be safely performed with low postoperative mortality and morbidity with excellent short- and long-term survival and freedom from major adverse events and angina with a reduced surgical invasiveness.

摘要

目的

微创直接冠状动脉旁路移植术（MIDCAB）用于前降支的左胸廓内动脉是一种安全且创伤较小的手术技术。我们回顾性评估了在一系列接受微创直接冠状动脉旁路移植术的患者中，长期随访的结果。

方法

1997 年至 2016 年，1060 例患者接受了微创直接冠状动脉旁路移植术：646 例（61%）为单纯左前降支近端病变，414 例（39%）为多支血管病变，包括杂交冠状动脉血运重建的一部分或与药物治疗联合。分析长期随访、主要心脑血管不良事件和无心绞痛发作的情况。

结果

患者平均年龄为 71±12.5 岁，欧洲心脏手术风险评估系统 II 中位数为 3.2%（四分位距 0.6%7.8%）。术后 9 例（0.8%）死亡，3 例（0.3%）发生围手术期卒中。在 10 年的随访期间（n=696）进行了血管造影或计算机断层扫描检查，结果显示旁路移植通畅率为 96.8%。在 13.9±5.6 年的随访中，左胸廓内动脉在前降支的旁路未因移植失败而再次手术干预，但 14 例患者接受了前降支或左胸廓内动脉在前降支的经皮冠状动脉介入治疗。Kaplan-Meier 生存曲线显示，5 年时的生存率为 87.1%（95%置信区间 81%92.5%），10 年时为 84.3%（95%置信区间 77.1%~~91.4%），15 年时为 79.8%（95%置信区间 72.2%~~87.3%）。5 年时，无重大不良事件的生存率为 87.0%（95%置信区间 85.9%~~88.1%），15 年时为 70.5%（95%置信区间 66.4%~~74.6%）。