Abazid Rami M, Khatami Alireza, Romsa Jonathan G, Warrington James C, Akincioglu Cigdem, Stodilka Robert Z, Fox Stephanie, Kiaii Bob, Vezina William C
Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada.
Division of Cardiac Surgery, London Health Sciences Centre, London, Canada.
J Thorac Dis. 2021 Feb;13(2):575-581. doi: 10.21037/jtd-20-2557.
The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery.
We reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH.
We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033.
RA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.
本研究的目的是确定机器人辅助冠状动脉搭桥术（RA-CABG）后食管裂孔疝（HH）的发生率/进展情况。
我们回顾了2000年至2017年间接受RA-CABG手术的491例患者的术前和术后计算机断层扫描（CT）。术后CT是按照研究方案前瞻性获取的。对CT进行评估以确定HH的存在和大小。
我们发现444/491（90.4%）的患者有术前CT，而201/491（40.9%）的患者有术后CT。总共有155/491（31.6%）的患者同时有术前和长期术后CT，平均随访时间为6.2（±3.5）年。HH在术后CT中更常见，术后CT中有64/155（41.3%），而术前CT中有44/155（28.4%），P<0.0001。术前存在的HH直径为2.8（±1.8）cm，术后显著增大至3.9（±2.5）cm，P<0.0001。同样，术前存在的HH体积为5.8（4.4-9.2）mL（四分位数），术后显著增大至14.1（7.2-64.9）mL，P<0.0001。20/155（12.9%）的患者在RA-CABG后出现了新的HH。一项包括HH危险因素的二元多变量回归分析显示，男性是RA-CABG后发生HH的预测因素，风险比为3.038，置信区间为（1.10-8.43），P=0.033。
RA-CABG与发生HH的风险增加相关，并会增大术前已存在的HH的大小。
