Sharma S, Daxini B V, Trivedi A, Mukherjee K, Pinto R, Bhattacharya S
Bombay Hospital and Medical Research Centre.
Indian Heart J. 1994 Nov-Dec;46(6):335-9.
This study deals with results of coronary artery reoperations in 21 males aged 54.4 +/- 6.6 years. Native vessel coronary disease at first and second operation was nearly the same (2.7 +/- 0.6 vs 2.8 +/- 0.4 vessel, p = NS). Graft attrition and deterioration in left ventricular ejection fraction (55.9 +/- 9.2 initial vs 36 +/- 15 at reoperation, p < 0.001) necessitated reoperation in majority. Recurrence of angina (71%) and left ventricular failure (23.8%) were the clinical indicators for reoperation. Procedure was successful in 20 (95%) and had to be abandoned in 1 due to severe pericardial and sternal adhesions. Arterial grafts were utilised in 90% (18 cases, Group A and B). Total arterial revascularisation (Group A) was done in 9 (45%) using Y graft 6, combination of both mammary arteries 2, and by both mammary and inferior epigastric artery in 1. Group B patients had arterial grafts (bilateral IMA 1, Y graft 1, bilateral IMA + gastroepipolic 1, RIMA 4, and LIMA 2) in addition to a venous graft. Two patients (group C, 10%) had only venous grafts. There was no in hospital mortality or morbidity and at 10 +/- 5.2 months follow up, all are asymptomatic with negative stress test at 3 months followup in 8 cases. We conclude that coronary artery reoperations using arterial conduits can be performed safely with excellent immediate and early results.
本研究涉及21名年龄在54.4±6.6岁男性的冠状动脉再次手术结果。首次和第二次手术时的自身血管冠状动脉疾病情况几乎相同（2.7±0.6支血管 vs 2.8±0.4支血管，p=无显著差异）。多数患者因移植血管损耗和左心室射血分数恶化（初次手术时为55.9±9.2，再次手术时为36±15，p<0.001）而需要再次手术。心绞痛复发（71%）和左心室衰竭（23.8%）是再次手术的临床指标。手术成功20例（95%），1例因严重的心包和胸骨粘连而不得不放弃手术。90%（18例，A组和B组）使用了动脉移植血管。9例（45%）进行了全动脉血管重建（A组），其中6例使用Y型移植血管，2例使用双侧乳内动脉联合，1例使用双侧乳内动脉和腹壁下动脉联合。B组患者除静脉移植血管外，还使用了动脉移植血管（双侧内乳动脉1例、Y型移植血管1例、双侧内乳动脉+胃网膜动脉1例、右内乳动脉4例、左内乳动脉2例）。2例患者（C组，10%）仅使用了静脉移植血管。住院期间无死亡或发病情况，在10±5.2个月的随访中，所有患者均无症状，8例患者在3个月随访时应激试验为阴性。我们得出结论，使用动脉管道进行冠状动脉再次手术可以安全进行，近期和早期效果良好。
