多支冠状动脉疾病的微创直接冠状动脉搭桥术与单支胸廓内动脉移植术：单中心回顾性分析
Minimally invasive direct coronary artery bypass versus single internal thoracic artery grafting procedures for multivessel coronary artery disease: a single-center retrospective analysis.
作者信息
Kakoush Mohammad, Gordon Amit, Farkash Ariel, Teich Nadav, Sela Orr, Pevni Dmitri, Ziv-Baran Tomer, Kfir Jonathan, Ben-Gal Yanai
机构信息
Department of Cardiothoracic Surgery, Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
J Cardiothorac Surg. 2025 Apr 11;20(1):188. doi: 10.1186/s13019-025-03410-0.
OBJECTIVE
To compare two surgical strategies for myocardial revascularization: one by a minimally invasive direct coronary artery bypass (MIDCAB) and the other by a conventional full sternotomy coronary artery bypass grafting (CABG).
METHODS
We reviewed the early outcomes and overall survival of all the patients treated in our center by the above strategies during 2000-2011.
RESULTS
Of 1915 patients, 1752 underwent conventional CABG utilizing a single internal thoracic artery (ITA) graft and 163 underwent a MIDCAB procedure. In the former compared to the latter, the patients were older and the median EuroSCORE was higher. The prevalences were higher of diabetes mellitus, recent myocardial infarction, emergency procedures, the.usage of an intra-aortic balloon pump, redo operations, and peripheral vascular disease; and the prevalences lower of chronic obstructive pulmonary disease and chronic renal failure. The median follow-up was 20 years. Early mortality (30 day) was greater in the conventional CABG group (3.6% vs. 0.6%, p = 0.042); and 10-, 15- and 20-year survival rates were lower: 55.1% vs. 76.7%, 37.1% vs. 63.7%, and 23.1% vs. 53.4%, respectively, p < 0.001. In an analysis that compared two matched groups of 134 patients each, early outcomes were similar, but late survival was lower following conventional CABG compared to MIDCAB after 10, 15 and 20 years: 64.7% vs. 74.6%, 44.7% vs. 64.1%, and 28.4% vs. 53.6% respectively, p = 0.004. In multivariable and univariate analysis, MIDCAB strategy compared to conventional single ITA CABG was associated with better late survival; the hazard ratio was 0.429 (95%CI 0.321-0.574, p < 0.001) for the whole cohort and 0.559 (95%CI: 0.376-0.831, p = 0.004), for the matched cohort.
CONCLUSIONS
Compared to conventional CABG utilizing a single ITA, the MIDCAB procedure demonstrated early safety and long-term effectiveness for surgical myocardial revascularization of the left anterior descending artery.
目的
比较两种心肌血运重建的手术策略：一种是微创直接冠状动脉旁路移植术（MIDCAB），另一种是传统的正中开胸冠状动脉旁路移植术（CABG）。
方法
我们回顾了2000年至2011年期间在本中心接受上述策略治疗的所有患者的早期结局和总体生存率。
结果
在1915例患者中，1752例行传统CABG，使用单根胸廓内动脉（ITA）移植，163例行MIDCAB手术。与后者相比，前者患者年龄更大，欧洲心脏手术风险评估系统（EuroSCORE）中位数更高。糖尿病、近期心肌梗死、急诊手术、主动脉内球囊泵的使用、再次手术和外周血管疾病的患病率更高；慢性阻塞性肺疾病和慢性肾衰竭的患病率更低。中位随访时间为20年。传统CABG组的早期死亡率（30天）更高（3.6%对0.6%，p = 0.042）；10年、15年和20年生存率更低：分别为55.1%对76.7%、37.1%对63.7%和23.1%对53.4%，p < 0.001。在一项对每组134例患者的两个匹配组进行比较的分析中，早期结局相似，但传统CABG术后10年、15年和20年的晚期生存率低于MIDCAB：分别为64.7%对74.6%、44.7%对64.1%和28.4%对53.6%，p = 0.004。在多变量和单变量分析中，与传统单根ITA CABG相比，MIDCAB策略与更好的晚期生存率相关；整个队列的风险比为0.429（95%CI 0.321 - 0.574，p < 0.001），匹配队列的风险比为0.559（95%CI：0.376 - 0.831，p = 0.004）。
结论
与使用单根ITA的传统CABG相比，MIDCAB手术在左前降支手术心肌血运重建方面显示出早期安全性和长期有效性。
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