Demirkıran Tuna, Akyol Furkan Burak, Özdem Tayfun, Hacızade Elgin, Kubat Emre, Erol Gökhan, Kadan Murat, Karabacak Kubilay
Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, Ankara, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Oct 30;32(4):402-411. doi: 10.5606/tgkdc.dergisi.2024.26471. eCollection 2024 Oct.
This study aimed to evaluate the efficacy and safety of total coronary revascularization via left anterior thoracotomy (TCRAT) by comparing it to conventional coronary artery bypass grafting (CABG) with median sternotomy.
In this retrospective study, 108 patients (95 males, 13 females; mean age: 57.1±8.8; range, 41 to 75 years) who underwent TCRAT (Group 1) and 154 patients (126 males, 28 females; mean age: 61.2±9.8; range, 31 to 79) who underwent conventional CABG (Group 2) between February 1, 2021, and September 1, 2022, were evaluated. The operations were performed by the same surgical team. Preoperative, operative, and postoperative data of patients and mid-term follow-up data were analyzed.
Mean cardiopulmonary bypass and cross-clamp times, respectively, were 167.70±68.93 and 77.03±38.18 min in Group 1 and 106.64±38.27 and 62.21±24.06 min in Group 2 (p<0.001). During the postoperative period, the all-cause mortality rate was 5.8% (n=9) in Group 2, while it was 0.9% (n=1) in Group 1; there was a statistically significant difference between the two groups (p=0.037). Nevertheless, the mean preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation) II was 2.59±2.3 in Group 2, which was significantly higher than the mean EuroSCORE II of Group 1 (1.37±1.5; p<0.001). The mean hospitalization duration for Group 2 was 6.99±3.37 days, and the mean hospitalization duration for Group 1 was 6.77±4.24 days. Duration of hospitalization was statistically significantly shorter in Group 1 (p=0.047). In addition, the mean perioperative number of erythrocyte suspension transfusions in Group 1 was 1.51±1.74, while it was 1.86±1.75 in Group 2. Significantly fewer erythrocyte suspension transfusions were performed in Group 1 (p=0.033).
The findings of our study indicate that TCRAT is a safe and viable technique when performed on a select patient group compared to the conventional method.
本研究旨在通过将经左前外侧开胸完全冠状动脉血运重建术（TCRAT）与传统正中开胸冠状动脉旁路移植术（CABG）进行比较，评估其疗效和安全性。
在这项回顾性研究中，对2021年2月1日至2022年9月1日期间接受TCRAT的108例患者（95例男性，13例女性；平均年龄：57.1±8.8岁；范围41至75岁）（第1组）和接受传统CABG的154例患者（126例男性，28例女性；平均年龄：61.2±9.8岁；范围31至79岁）（第2组）进行了评估。手术由同一手术团队进行。分析了患者的术前、术中、术后数据以及中期随访数据。
第1组的平均体外循环时间和主动脉阻断时间分别为167.70±68.93分钟和77.03±38.18分钟，第2组分别为106.64±38.27分钟和62.21±24.06分钟（p<0.001）。术后期间，第2组的全因死亡率为5.8%（n = 9），而第1组为0.9%（n = 1）；两组之间存在统计学显著差异（p = 0.037）。然而，第2组术前平均欧洲心脏手术风险评估系统（EuroSCORE）II为2.59±2.3，显著高于第1组的平均EuroSCORE II（1.37±1.5；p<0.001）。第2组的平均住院时间为6.99±3.37天，第1组的平均住院时间为6.77±4.24天。第1组的住院时间在统计学上显著更短（p = 0.047）。此外，第1组围手术期红细胞悬液输注的平均次数为1.51±1.74，第2组为1.86±1.75。第1组进行的红细胞悬液输注显著更少（p = 0.033）。
我们的研究结果表明，与传统方法相比，TCRAT在特定患者群体中实施时是一种安全可行的技术。
