Tappainer E, Fabbri A, Pessotto R, Luciani G B, Mazzuco A
Divisione e Cattedra di Cardiochirurgia, Università di Verona, Italy.
J Card Surg. 1995 Sep;10(5):559-63. doi: 10.1111/j.1540-8191.1995.tb00632.x.
To increase the number of arterial grafts in patients with multivessel coronary disease, we have used branches of the left internal mammary artery (LIMA) as bypass grafts. From March 1990 to June 1993, 15 patients (13 males and 2 females) aged 38 to 65 years (mean 57 +/- 8), received a total of 30 LIMA branch anastomoses. The two terminal branches were used to perform a "Y" graft to the left anterior descending coronary artery territory in 13 patients. A pericardiophrenic branch was used in four cases. Five patients (33.3%) had complete myocardial revascularization using IMA only. There were neither early nor late deaths and all patients are free from angina at a mean follow-up of 20 months (6 to 45 months). However, early postoperative cardiac catheterization, performed in 12 patients (80%), revealed a 20% occlusion rate for each terminal branch and a 50% occlusion rate for the pericardiophrenic branch. Technically challenging due to the small diameter of the grafts, the terminal LIMA branches should be limited to selected patients when more conventional arterial or vein conduits are not available. More proximal branches have a higher occlusion rate and their use is not recommended.
为增加多支冠状动脉疾病患者的动脉移植物数量，我们使用了左乳内动脉（LIMA）的分支作为旁路移植物。从1990年3月至1993年6月，15例患者（13例男性和2例女性），年龄38至65岁（平均57±8岁），共接受了30次LIMA分支吻合术。13例患者中，使用两个终末分支对左冠状动脉前降支区域进行“Y”形移植。4例使用了心包膈动脉分支。5例患者（33.3%）仅使用内乳动脉实现了完全心肌血运重建。无早期或晚期死亡病例，平均随访20个月（6至45个月）时，所有患者均无心绞痛症状。然而，12例患者（80%）术后早期进行的心脏导管检查显示，每个终末分支的闭塞率为20%，心包膈动脉分支的闭塞率为50%。由于移植物直径小，技术操作具有挑战性，当无法使用更传统的动脉或静脉导管时，LIMA终末分支应仅限于特定患者。更靠近近端的分支闭塞率更高，不建议使用。
