Department of Cardiothoracic Surgery, Waikato Hospital, Waikato, New Zealand; Department of Surgery, Auckland University, Auckland, New Zealand.
Department of Cardiothoracic Anesthesia, Waikato Hospital, Waikato, New Zealand.
Heart Lung Circ. 2021 Apr;30(4):605-611. doi: 10.1016/j.hlc.2020.08.007. Epub 2020 Sep 18.
Multiple overlapping stents (Full metal jacket, FMJ) from percutaneous coronary artery intervention (PCI) renders coronary artery bypass modus operandi unmanageable. We report our surgical revascularisation in patients with failed full metal jacket of left anterior descending coronary artery (FMJ-LAD).
We reviewed 22 patients who presented with FMJ-LAD From 2006 to 2019. Extensive endarterectomy involving almost the whole length of the left anterior descending (LAD) was performed, the arteriotomy patched up with a saphenous vein. All reconstructed LADs were grafted with the left internal mammary artery. We compared the group to propensity-matched patients with single proximal LAD lesions requiring coronary artery bypass graft (CABG).
The mean age was 54±3.5 years. Twenty-one (21) patients (95%) were in angina class III or IV despite maximum medical therapy. Fourteen (14) patients (63.6%) presented with MI within 1 month. All patients had a preoperative positive test for ischaemia. Cross-clamp and bypass times were significantly shorter (25.5±7 mins and 65±5 mins, versus 52±3 mins and 77.2±4 mins) in the CABG group compared to FMJ-LAD group, the mean hospital stay of 6±1.5 days was not different between the groups. Postoperative electrocardiograms showed non-specific changes in 75% (n=16) with no enzyme rise. Early postoperative angiography was performed in 10 patients because of the new electrocardiograph (ECG) changes; all FMJ-LAD patients had an angiogram at 1 year, two late angiograms (2 and 3 years postoperatively), and one computed tomography (CT)-angiogram for readmission with angina. All patients in the FMJ-LAD group had 12 months follow-up angiogram or cardiac CT scan. All the endarterectomies' LADs were patent. There was no mortality within the 30 days. Patients' follow-up time was between 1-13 years.
Open stent endarterectomy is a valuable alternative option for patients with "full metal jacket" diseased LAD that is not graftable using standard techniques with acceptable midterm results.
经皮冠状动脉介入治疗（PCI）中多个重叠的支架（全金属护套，FMJ）使冠状动脉旁路术的操作变得难以处理。我们报告了在左前降支（LAD）完全金属护套失败的患者中进行的手术血运重建。
我们回顾了 2006 年至 2019 年期间 22 例 LAD 完全金属护套（FMJ-LAD）的患者。进行了广泛的内膜切除术，涉及 LAD 的几乎整个长度，动脉切开处用隐静脉修补。所有重建的 LAD 均与左内乳动脉吻合。我们将该组与需要冠状动脉旁路移植术（CABG）的单一近端 LAD 病变的倾向匹配患者进行了比较。
平均年龄为 54±3.5 岁。21 例（95%）患者尽管接受了最大程度的药物治疗，但仍处于心绞痛 III 或 IV 级。14 例（63.6%）患者在 1 个月内发生心肌梗死。所有患者术前均有缺血阳性试验。CABG 组的体外循环和旁路时间明显短于 FMJ-LAD 组（分别为 25.5±7 分钟和 65±5 分钟，52±3 分钟和 77.2±4 分钟），两组的平均住院时间无差异（6±1.5 天）。术后心电图显示 75%（n=16）有非特异性改变，无酶升高。由于新的心电图（ECG）改变，10 例患者进行了早期术后血管造影术；所有 FMJ-LAD 患者在 1 年内、2 年和 3 年后各进行了 1 次血管造影术，1 例因心绞痛再次入院进行了计算机断层扫描（CT）血管造影术。FMJ-LAD 组的所有患者均进行了 12 个月的随访血管造影或心脏 CT 扫描。所有内膜切除术的 LAD 均通畅。30 天内无死亡。患者的随访时间为 1-13 年。
对于无法使用标准技术进行移植的“全金属护套”病变 LAD 患者，开放性支架内膜切除术是一种有价值的替代选择，具有可接受的中期结果。
