Sellin Christian, Belmenai Ahmed, Niethammer Margit, Schächinger Volker, Dörge Hilmar
Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany.
Department of Cardiology, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany.
JTCVS Tech. 2024 Jun 3;26:52-60. doi: 10.1016/j.xjtc.2024.05.018. eCollection 2024 Aug.
A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing.
From November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months).
Left internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%.
This is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.
经左前开胸的保留胸骨微创全冠状动脉血运重建方法在未经选择的多支冠状动脉疾病患者中显示出良好的早期结果。随访数据仍然缺失。
2019年11月至2023年9月，对392例连续的非急诊患者（345例男性；67.0±9.9岁；范围32 - 88岁）进行了体外循环和心脏停搏下经左前小切口冠状动脉旁路移植术，作为常规手术。所有患者均患有多支冠状动脉疾病（77.6%为三支血管病变，22.4%为两支血管病变，32.9%为左主干狭窄）。纳入了老年患者（年龄大于80岁，12.5%）、严重左心室功能不全患者（射血分数<30%，7.9%）、糖尿病患者（34.9%）、重度肥胖患者（体重指数>35，8.9%）和慢性肺病患者（17.1%）。欧洲心脏手术风险评估系统II评分平均为2.9±2.8。中期随访（100%）平均为15.2±10.7个月（范围0.1 - 39.5个月）。
使用了左乳内动脉（99.0%）、桡动脉（70.4%）和大隐静脉移植物（57.4%），70.4%的患者接受了至少2支动脉移植物。每位患者平均进行3.0±0.8次吻合（范围为2 - 5次吻合），以实现左前降支（98.7%）、回旋支（91.6%）和右冠状动脉（70.9%）区域的血运重建。95.1%的患者实现了完全解剖学血运重建。随访时，全因死亡率、心肌梗死、再次血运重建和卒中发生率分别为3.1%、1.5%、5.4%和0.7%。总体主要不良心脑血管事件发生率为8.7%。
这是关于经左前开胸对多支冠状动脉疾病进行常规保留胸骨全冠状动脉血运重建术后中期随访的首份报告，该手术多支动脉移植物使用率高且实现了完全解剖学血运重建。结果良好，与当代传统冠状动脉旁路移植术相似。
