Liu D X, Chen X J, Zheng B S, Cao Y, Chen K M, Shi C, Lin Y, Cao G Q, Li W D, Luo J H, Yin X Q, Cao Q S, Lei Y S, Yang W K, Zhou J W, Wei W L, Wang G L, Liu D B, Hu M S, Lu H H, Yang M, Song B G, Wang H C, Wang Z D, Chen Q S
Department of Cardiac Surgery, the First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China.
Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical School of Huazhong University of Science and Technology, Wuhan 430022, China.
Zhonghua Yi Xue Za Zhi. 2020 May 12;100(18):1390-1395. doi: 10.3760/cma.j.cn112137-20200102-00010.
To evaluate the clinical outcomes of on-pump total arterial revascularization with bilateral radial artery (BRA) and left internal mammary artery (LIMA) as conduits in coronary artery bypass grafting (CABG) patients with left ventricular dysfunction (LVD). All the perioperative medical records and follow-up results of coronary artery disease patients with left ventricular ejection fraction (LVEF) ≤ 40% undergoing CABG from 24 heart centers of 15 provinces and autonomous regions in China between July 2015 and December 2019 were retrospectively analyzed. A total of 87 consecutive patients (55 males and 32 females) underwent on-pump CABG with BRA and LIMA, with a mean age of (57.5±9.1) years old. There were 22 patients complicated with primary hypertension, 12 with diabetes mellitus, 8 with peripheral vascular disease, 7 with chronic obstructive lung disease, 12 with mild renal injury and 3 with partial aortic calcification. There were 43 cases with in-stent stenosis, and 21 had left main disease. The mean LVEF and left ventricular end-diastolic diameter (LVEDD) was (35.5±7.3)% and (65.5±2.6) mm, respectively. The mean graft number, aortic cross-clamp time and cardiopulmonary bypass duration was 3.2±0.9, (90.5±22.7) min and (113.4±19.2) min, respectively. There were 32 mitral and 9 aortic valve replacements, and 5 tricuspid annuloplasties. Prophylactic intra-aortic balloon pumps were implanted in 27 patients. There were 2 operative deaths from acute heart failure. After surgery, there were 15 cases of atrial fibrillation, 1 case of acute kidney injury, 1 case of acute myocardial infarction, and 1 cases of stroke. All the patients fulfilled the follow-up, with a mean time of (39.5±7.7) months. At 3 months after surgery, LVEDD was decreased and LVEF was improved significantly compared with pre-operative indicators [(53.0±1.5) mm vs (65.5±2.6) mm, 9.51 0.02; (45.2±3.3)% vs (35.5±7.3)%, 13.79, 0.001]. No major cardiac events were reported during the follow-up. At (30.5±7.4) months after surgery, 62.4% of patients (53/85) underwent coronary CT angiography examination, and the results indicated that the graft patency was 98.8%, with only one case of RA occlusion occurred. In selected patients of LVD, on-pump total arterial revascularization with BRA and LIMA conduits was proved to be safe and effective.
评估在冠状动脉旁路移植术（CABG）合并左心室功能障碍（LVD）患者中，使用双侧桡动脉（BRA）和左乳内动脉（LIMA）作为管道进行体外循环下全动脉血管重建的临床结果。回顾性分析了2015年7月至2019年12月期间，来自中国15个省、自治区24个心脏中心的冠状动脉疾病患者，这些患者左心室射血分数（LVEF）≤40%，接受了CABG手术，分析了他们所有的围手术期病历和随访结果。共有87例连续患者（55例男性和32例女性）接受了使用BRA和LIMA的体外循环CABG手术，平均年龄为（57.5±9.1）岁。有22例患者合并原发性高血压，12例合并糖尿病，8例合并外周血管疾病，7例合并慢性阻塞性肺疾病，12例合并轻度肾损伤，3例合并部分主动脉钙化。有43例患者存在支架内狭窄，21例患有左主干病变。平均LVEF和左心室舒张末期内径（LVEDD）分别为（35.5±7.3）%和（65.5±2.6）mm。平均移植血管数量、主动脉阻断时间和体外循环持续时间分别为3.2±0.9、（90.5±22.7）分钟和（113.4±19.2）分钟。有32例二尖瓣置换和9例主动脉瓣置换，以及5例三尖瓣成形术。27例患者植入了预防性主动脉内球囊泵。有2例手术死亡，原因是急性心力衰竭。术后有15例房颤，1例急性肾损伤，1例急性心肌梗死和1例中风。所有患者均完成了随访，平均随访时间为（39.5±7.7）个月。术后3个月，与术前指标相比，LVEDD降低，LVEF显著改善[（53.0±1.5）mm对（65.5±2.6）mm，9.51，0.02；（45.2±3.3）%对（35.5±7.3）%，13.79，0.001]。随访期间未报告重大心脏事件。术后（30.5±7.4）个月，62.4%的患者（53/85）接受了冠状动脉CT血管造影检查，结果显示移植血管通畅率为98.8%，仅发生1例桡动脉闭塞。在选定的LVD患者中，使用BRA和LIMA管道进行体外循环下全动脉血管重建被证明是安全有效的。
