Knochenhauer Tim, Schneeberger Yvonne, Beyer Martin, Sobik Friedrich, Hua Xiaoqin, Reiter Beate, Brickwedel Jens, Zipfel Svante, Reichenspurner Hermann, Conradi Lenard, Sill Bjoern, Schaefer Andreas
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Interdiscip Cardiovasc Thorac Surg. 2025 May 6;40(5). doi: 10.1093/icvts/ivaf100.
In our centre, a bilateral internal mammary artery first approach is established from day 1 of surgical training. We herein aimed to investigate safety and clinical efficacy of this training concept.
All patients undergoing isolated bypass grafting between 2009 and 2021 at our institution were included in this study. Patients provided with single mammary artery, radial artery or vein grafts were excluded. According to a preoperative evaluation conducted by experienced coronary bypass surgeons, coronary artery disease severity was classified, and patients were allocated to group 1 (surgery performed by staff surgeons) and group 2 (surgery performed by residents under supervision of staff surgeons). Thirty-day outcome parameters were compared between groups.
A total of 2125 patients were allocated to group 1, and 431 patients were assigned to group 2. Patients in group 1 presented a higher risk profile. Coronary artery bypass grafting in group 2 was more often performed as on-pump procedure with a longer procedure duration. Number of performed bypasses was lower in group 2 with fewer composite grafting and fewer anastomoses to the RCA territory. No significant differences in 30-day all-cause mortality, myocardial infarction, stroke or acute kidney injury were seen.
Thirty-day outcomes after coronary artery bypass grafting using bilateral internal mammary artery grafts performed by residents were without significant differences to outcomes of staff surgeons, suggesting that application of both internal mammary arteries by residents is safe and effective when performed under supervision and after preoperative patient screening.
在我们中心，从外科培训的第一天起就确立了双侧乳内动脉优先的方法。我们在此旨在研究这一培训理念的安全性和临床疗效。
本研究纳入了2009年至2021年在我们机构接受单纯搭桥手术的所有患者。接受单支乳内动脉、桡动脉或静脉移植的患者被排除。根据经验丰富的冠状动脉搭桥外科医生进行的术前评估，对冠状动脉疾病的严重程度进行分类，并将患者分为1组（由主治医生进行手术）和2组（由住院医生在主治医生监督下进行手术）。比较两组的30天结局参数。
共有2125例患者被分配到1组，431例患者被分配到2组。1组患者的风险特征更高。2组的冠状动脉搭桥手术更多是在体外循环下进行，手术时间更长。2组的搭桥数量较少，复合移植较少，与右冠状动脉区域的吻合较少。在30天全因死亡率、心肌梗死、中风或急性肾损伤方面未见显著差异。
住院医生使用双侧乳内动脉进行冠状动脉搭桥手术后的30天结局与主治医生的结局无显著差异，这表明住院医生在术前患者筛查后并在监督下应用双侧乳内动脉是安全有效的。
