Cardiac Surgery Department, Peking University People's Hospital, BeiJing, 100044, China.
J Cardiothorac Surg. 2021 Jan 6;16(1):2. doi: 10.1186/s13019-020-01380-z.
A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA.
There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared.
There was no difference in the early postoperative death and major complications between group I and Group II(P>0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P>0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value (71.4 ± 7.8 vs 61.8 ± 18.1,P = 0.025). The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup (3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent.
The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.
大量研究表明，与单支内乳动脉桥相比，双侧内乳动脉桥在心脏功能保护和术后长期生存方面具有优势。然而，对于如何选择最佳的桥血管配置，目前仍没有共识。本研究旨在比较不同内乳动脉桥血管（BIMA）配置的术中血流、早期临床结果和早期术后通畅率。
纳入了 74 例行双侧内乳动脉搭桥术的患者，根据右内乳动脉（RIMA）吻合的不同靶区，将患者分为双侧组（I 组）20 例和左侧组（II 组）54 例。比较了不同 BIMA 配置的术中血流、早期临床结果和早期术后通畅率。
I 组和 II 组患者的术后早期死亡率和主要并发症无差异（P>0.05）。与 II 组的 LIMA 相比，I 组的 LIMA 有稍高的 DF 值（76.7±6.2 vs 73.1±6.8，P=0.040）。与 II 组的 RIMA 相比，I 组的 RIMA 有稍高的 MGF（51.7±34.4 ml/min vs 31.4±21.4 ml/min，P=0.024）。I 组和 II 组 LIMA 和 RIMA 的其他 TTFM 参数无差异（P>0.05）。进一步的亚组分析显示，与 II 组游离 RIMA 相比，原位 RIMA 有稍高的 DF 值（71.4±7.8 vs 61.8±18.1，P=0.025）。游离 RIMA 亚组的 LIMA 的 PI 高于原位 RIMA 亚组（3.0±1.6 vs 2.1±1.0，P=0.018）。术后早期 CTA 检查结果显示所有 IMAs 桥血管均完全通畅。
BIMA 用于 CABG 是安全有效的，RIMA 用于右冠状动脉吻合时获得了更满意的桥血管血流。BIMA 在早期没有狭窄和闭塞，因此是理想和稳定的冠状动脉旁路移植桥。
