Harris Dwight D, Chu Louis, Sabe Sharif A, Doherty Michelle, Senthilnathan Venkatachalam
Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Clin Med. 2024 Aug 16;13(16):4831. doi: 10.3390/jcm13164831.
Coronary artery bypass grafting remains the standard of care for advanced and multifocal coronary artery disease; however, for patients that are surgical candidates, total arterial revascularization (TAR) remains underutilized due to concerns such as sternal wound infections and the learning curve. We present the results of a large cohort of mid-career surgeons transitioning to TAR, focusing on short-term outcomes and the learning curve. The surgeons transitioned to using TAR as the preferred revascularization technique in August of 2017. The Society of Thoracic Surgeons database was reviewed to identify all patients who underwent isolated non-emergent CABG performed by a single surgeon from January 2014 through January 2022. Patients were divided into two groups-those who had TAR and those who had traditional CABG using one internal mammary artery and vein grafts (IMA-SVG). Eight hundred ninety-eight patients meet inclusion criteria (458 IMA-SVG and 440 TAR). The TAR group had slightly longer cardiopulmonary bypass time, cross clamp times, and operative times (all < 0.05); however, ICU stay was shorter and 30-day readmission rate was lower for TAR compared to IMA-SVG (all < 0.05). The TAR group also required fewer postoperative transfusions ( = 0.005). There was no difference in prolonged intubation, stroke, length of stay, mortality, or sternal wound complications between groups (all > 0.05). The average TAR was 30 min longer; however, learning curves, stratified by number of grafts placed, showed no significant learning curve associated with TAR. An experienced surgeon transitioning from IMA-SVG to TAR slightly increases operative time, but decreases ICU stay, readmissions, and postoperative transfusions with no significant difference in rates of immediate post-operative complications or 30-day mortality, with a minimal learning curve.
冠状动脉搭桥术仍然是治疗晚期和多灶性冠状动脉疾病的标准治疗方法；然而，对于适合手术的患者，由于担心如胸骨伤口感染和学习曲线等问题，全动脉血运重建（TAR）的应用仍然不足。我们展示了一大群中年外科医生向TAR过渡的结果，重点关注短期结果和学习曲线。这些外科医生于2017年8月开始将TAR作为首选的血运重建技术。回顾了胸外科医师协会数据库，以确定2014年1月至2022年1月期间由一名外科医生进行的孤立非急诊冠状动脉搭桥术的所有患者。患者分为两组——接受TAR的患者和接受使用一根乳内动脉和静脉移植物的传统冠状动脉搭桥术（IMA-SVG）的患者。898名患者符合纳入标准（458例IMA-SVG和440例TAR）。TAR组的体外循环时间、主动脉阻断时间和手术时间略长（均<0.05）；然而，与IMA-SVG相比，TAR组的重症监护病房停留时间更短，30天再入院率更低（均<0.05）。TAR组术后输血也更少（P = 0.005）。两组之间在延长插管、中风、住院时间、死亡率或胸骨伤口并发症方面没有差异（均>0.05）。平均TAR时间长30分钟；然而，按所放置移植物数量分层的学习曲线显示，TAR没有显著的学习曲线。一名从IMA-SVG过渡到TAR的经验丰富的外科医生手术时间略有增加，但重症监护病房停留时间、再入院率和术后输血减少，术后即刻并发症发生率或30天死亡率没有显著差异，学习曲线最小。
