Cosgrove D M, Lytle B W, Loop F D, Taylor P C, Stewart R W, Gill C C, Golding L A, Goormastic M
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44106.
J Thorac Cardiovasc Surg. 1988 May;95(5):850-6.
The risk of bilateral internal mammary artery grafting was studied in three groups of patients who were computer matched for recognized risk factors: year of operation, age, gender, extent of coronary artery disease, left ventricular function, completeness of myocardial revascularization, and history of congestive heart failure. The patient groups differed in the fact that they received veins only, one internal mammary artery graft, or two internal mammary artery grafts. The operative mortality rates for these three groups were 1.8%, 0.3%, and 0.9%, respectively (no significant difference). Analysis of perioperative morbidity demonstrated no significant differences except for a slight increase in transfusion requirements in the group receiving two internal mammary artery grafts (p = 0.04). None of the patients with only vein grafts had wound complications. One patient in the group with one internal mammary artery graft had a wound complication (0.03%). Eight patients receiving two internal mammary artery grafts had wound complications (2.4%) (p = 0.002). The prevalence of wound complications in patients with diabetes mellitus was 5.7% and in those without diabetes mellitus, 0.3% (p = 0.01). The prevalence of wound complications in patients less than 60 years of age was 0.2%, in patients in their 60s, 1.6%, and in patients older than 70, 3.1% (p = 0.01). Multivariate logistic regression analysis identified diabetes mellitus and age and not bilateral internal mammary artery grafting as risk factors for wound complications. We conclude that bilateral internal mammary artery grafting does not increase surgical mortality and increases surgical morbidity by a slight increase in the mean transfusion requirement.
在三组患者中研究了双侧乳内动脉移植的风险，这些患者根据公认的风险因素进行计算机匹配：手术年份、年龄、性别、冠状动脉疾病程度、左心室功能、心肌血运重建的完整性以及充血性心力衰竭病史。患者组的不同之处在于，他们分别仅接受静脉移植、一根乳内动脉移植或两根乳内动脉移植。这三组的手术死亡率分别为1.8%、0.3%和0.9%（无显著差异）。围手术期发病率分析显示，除接受两根乳内动脉移植的组输血需求略有增加外（p = 0.04），无显著差异。仅接受静脉移植的患者均无伤口并发症。接受一根乳内动脉移植的组中有1例患者出现伤口并发症（0.03%）。接受两根乳内动脉移植的8例患者出现伤口并发症（2.4%）（p = 0.002）。糖尿病患者伤口并发症的发生率为5.7%，非糖尿病患者为0.3%（p = 0.01）。年龄小于60岁的患者伤口并发症发生率为0.2%，60多岁的患者为1.6%，70岁以上的患者为3.1%（p = 0.01）。多因素逻辑回归分析确定糖尿病和年龄而非双侧乳内动脉移植是伤口并发症的风险因素。我们得出结论，双侧乳内动脉移植不会增加手术死亡率，只会因平均输血需求略有增加而增加手术发病率。
