Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany.
Department for Quality and Risk Management and Patient Safety, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany.
Thorac Cardiovasc Surg. 2021 Oct;69(7):607-613. doi: 10.1055/s-0041-1723845. Epub 2021 May 27.
High-risk patients with multivessel disease (MVD) including a complex stenosis of the left anterior descending coronary may not be ideal candidates for guideline compliant therapy by coronary artery bypass grafting (CABG) regarding invasiveness and perioperative complications. However, they may benefit from minimally invasive direct coronary artery bypass (MIDCAB) grafting and hybrid revascularization (HCR).
A logistic European system for cardiac operative risk evaluation score (logES) >10% defined high risk. In high-risk patients with MVD undergoing MIDCAB or HCR, the incidence of major adverse cardiac and cerebrovascular events (MACCEs) after 30 days and during midterm follow-up was evaluated.
Out of 1,250 patients undergoing MIDCAB at our institution between 1998 and 2015, 78 patients (logES: 18.5%; age, 76.7 ± 8.6 years) met the inclusion criteria. During the first 30 days, mortality and rate of MACCE were 9.0%; early mortality was two-fold overestimated by logES. Complete revascularization as scheduled was finally achieved in 64 patients (82.1%). Median follow-up time reached 3.4 (1.2-6.5) years with a median survival time of 4.7 years. Survival after 1, 3, and 5 years was 77, 62, and 48%.
In high-risk patients with MVD, MIDCAB is associated with acceptable early outcome which is better than predicted by logES. Taking the high-risk profile into consideration, midterm follow-up showed satisfying results, although scheduled HCR was not realized in a relevant proportion. In selected cases of MVD, MIDCAB presents an acceptable alternative for high-risk patients.
对于多血管病变（MVD）的高危患者，包括左前降支的复杂狭窄，由于其侵袭性和围手术期并发症，他们可能不是符合指南的经皮冠状动脉旁路移植术（CABG）的理想治疗选择。然而，他们可能受益于微创直接冠状动脉旁路移植术（MIDCAB）和杂交血运重建（HCR）。
Logistic 欧洲心脏手术风险评估系统评分（logES）＞10%定义为高危。在接受 MIDCAB 或 HCR 的 MVD 高危患者中，评估 30 天后和中期随访期间主要不良心脏和脑血管事件（MACCEs）的发生率。
在我们机构 1998 年至 2015 年期间接受 MIDCAB 的 1250 例患者中，有 78 例患者（logES：18.5%；年龄 76.7±8.6 岁）符合纳入标准。在最初的 30 天内，死亡率和 MACCE 发生率为 9.0%；logES 高估了早期死亡率两倍。最终有 64 例患者（82.1%）按计划完成完全血运重建。中位随访时间达到 3.4（1.2-6.5）年，中位生存时间为 4.7 年。1、3 和 5 年的生存率分别为 77%、62%和 48%。
在 MVD 的高危患者中，MIDCAB 相关的早期结果可接受，且优于 logES 的预测。考虑到高危患者的情况，中期随访结果令人满意，尽管按计划进行的 HCR 并未在相关比例中实现。在 MVD 的选择病例中，MIDCAB 为高危患者提供了一种可接受的替代方案。
