Suma H, Takeuchi A, Kondo K, Maeda M, Fukumoto H, Kimura H, Sato H, Hasegawa S
Department of Thoracic Surgery, Osaka Medical College, Japan.
J Thorac Cardiovasc Surg. 1988 Sep;96(3):393-9.
The results of internal mammary artery grafting in 50 patients with a body surface area less than 1.6 m2 were compared with those in 54 patients with a larger body surface area. Age (58.8 +/- 8.2 versus 54.9 +/- 10.3 years old) and prevalence of female gender (28% versus 4%) were significantly different between the group of patients with a small body surface area and the group with a large body surface area, respectively. However, the prevalence of unstable angina, previous myocardial infarction, extent of coronary artery disease, and preoperative ejection fraction was not significantly different between the two groups. The mean number of distal anastomoses was 3.0 and 2.8, and the mean duration of aortic occlusion was 65.6 +/- 23.0 minutes and 59.5 +/- 21.7 minutes in the small and large body surface area groups, respectively (not significant). The mean free flow rate of the internal mammary artery was 65.6 +/- 16.8 ml/min in the small body surface area group and 78.0 +/- 21.6 ml/min in the large body surface area group (p less than 0.05). The diameters of the anterior descending and the circumflex arteries were significantly smaller in the small body surface area group. Two patients (4%) died within 30 days of operation and one patient died later in the small body surface area group, whereas no death was noted in the large body surface area group (not significant). No significant differences were found in the incidence of aortic balloon pumping, perioperative myocardial infarction, and serious postoperative complications between the two groups. Symptomatic relief was equally good in both groups (92% and 96%). The patency rate of the internal mammary artery was 95% (42/44) in the small body surface area group and 100% (48/48) in the large body surface area group within 1 year, mean 2.3 +/- 2.4 months. In conclusion, internal mammary artery grafting can be performed safely and effectively even in patients with small body structure. Though the blood flow of the internal mammary artery and the size of the coronary arteries were smaller in patients with small body structure, excellent patency of the internal mammary artery graft and satisfactory symptomatic relief can be expected.
对50例体表面积小于1.6平方米的患者与54例体表面积较大的患者进行了乳内动脉移植的结果比较。体表面积小的患者组与体表面积大的患者组之间，年龄（分别为58.8±8.2岁和54.9±10.3岁）及女性患病率（分别为28%和4%）存在显著差异。然而，两组之间不稳定型心绞痛患病率、既往心肌梗死情况、冠状动脉疾病程度及术前射血分数无显著差异。体表面积小的组和体表面积大的组远端吻合的平均数量分别为3.0和2.8，主动脉阻断的平均持续时间分别为65.6±23.0分钟和59.5±21.7分钟（无显著差异）。体表面积小的组乳内动脉的平均自由血流率为65.6±16.8毫升/分钟，体表面积大的组为78.0±21.6毫升/分钟（p<0.05）。体表面积小的组前降支和回旋支动脉直径明显较小。体表面积小的组有2例患者（4%）在术后30天内死亡，1例患者随后死亡，而体表面积大的组未观察到死亡情况（无显著差异）。两组之间主动脉球囊泵入、围手术期心肌梗死及严重术后并发症的发生率无显著差异。两组症状缓解情况同样良好（分别为92%和96%）。1年内，体表面积小的组乳内动脉通畅率为95%（42/44），体表面积大的组为100%（48/48），平均时间为2.3±2.4个月。总之，即使是身体结构较小的患者，乳内动脉移植也能安全有效地进行。虽然身体结构较小的患者乳内动脉血流及冠状动脉尺寸较小，但乳内动脉移植物的通畅率良好，症状缓解令人满意。
