Chaban Ryan, Ghazy Ahmed, Treede Hendrik
Department of Cardiovascular Surgery, University Hospital of Johannes Gutenberg University, 55131 Mainz, Germany.
Rev Cardiovasc Med. 2023 Jan 3;24(1):4. doi: 10.31083/j.rcm2401004. eCollection 2023 Jan.
The benefits of utilizing internal thoracic arteries (ITAs) in coronary bypass surgery are well-known. However, the safety of this practice in elderly patients needs to be proven.
We studied all patients who are 75 years of age and older, who received at least one ITA graft while undergoing isolated, conventional (median sternotomy) coronary artery bypass graft surgery (CABG) between Jan 1st 2002 and Dec 31st 2020 (19 years). Emergent surgeries were excluded. Propensity score matching was used to reduce the patient selection effect. Study outcomes were 30-days mortality, and two sets of dependent intraoperative parameters and postoperative parameters.
A total of 1855 patients undergoing CABG was included, of which 1114 received a single left (s)ITA and 741 received combined left and right (d)ITA grafts. 519 pairs were matched. The decision for sITA or dITA was made individually. Thirty-days mortality was low and similar in both groups (sITA 3.3%; dITA 2.9%, = 0.859). The incidence of sternal wound healing disorder was higher after dITA (3.3 vs 6.9%; 0.011), which had also a longer skin-to-skin operative time (181 vs 205 min; 0.0001). Re-thoracotomy rates were similar (4.6 vs 6.2%; = 0.340). There were no significant differences in other secondary parameters.
harvesting both ITAs in elderly patients is safe and feasible. However, it increases the risk of sternal wound healing disorders. Long term benefit still needs to be proven.
在冠状动脉搭桥手术中使用胸廓内动脉（ITA）的益处是众所周知的。然而，这种做法在老年患者中的安全性需要得到证实。
我们研究了2002年1月1日至2020年12月31日（19年）期间所有75岁及以上、在接受孤立的传统（正中开胸）冠状动脉搭桥手术（CABG）时接受至少一根ITA移植的患者。急诊手术被排除在外。采用倾向评分匹配法以减少患者选择效应。研究结局为30天死亡率，以及两组相关的术中参数和术后参数。
总共纳入了1855例行CABG的患者，其中1114例接受了单根左胸廓内动脉（sITA）移植，741例接受了左右胸廓内动脉联合（dITA）移植。匹配了519对。sITA或dITA的决策是单独做出的。两组的30天死亡率都很低且相似（sITA为3.3%；dITA为2.9%，P = 0.859）。dITA术后胸骨伤口愈合障碍的发生率更高（3.3%对6.9%；P = 0.011），其皮肤对皮肤的手术时间也更长（181分钟对205分钟；P = 0.0001）。再次开胸率相似（4.6%对6.2%；P = 0.340）。其他次要参数没有显著差异。
在老年患者中采集双侧ITA是安全可行的。然而，这会增加胸骨伤口愈合障碍的风险。长期益处仍需证实。
