Velebit V, Christenson J T, Maurice J, Simonet F, Schmuziger M
Cardiovascular Surgery Unit, Hôpital de la Tour, Meyrin-Geneva, Switzerland.
Tex Heart Inst J. 1994;21(2):125-9.
In order to evaluate the potential risks of a patent internal mammary artery bypass at reoperative coronary artery bypass grafting, we have reviewed the records of 233 consecutive patients undergoing reoperative coronary artery bypass grafting between 1 January 1991 and 31 December 1993, including 209 patients having an occluded mammary graft or no mammary graft (Group I) and 24 patients having a patent mammary graft (Group II). With regard to preoperative patient characteristics, the only significant differences between the groups were: Group II patients had a higher preoperative left ventricular ejection fraction than did Group I patients (63.7% +/- 8.9% vs. 52.1% +/- 10.1%, p < 0.001); and Group II patients had received fewer grafts per patient than had patients in Group I (2.2 +/- 1.1 vs 3.6 +/- 1.4 grafts per patient, p < 0.001). There were no entry injuries to the grafts or to the heart in either of the groups. No perioperative mortality was encountered in Group II, while 11 patients died in Group I (p < 0.05). Group II had a significantly higher incidence of reexploration for post-operative bleeding, whereas Group I had a significantly higher incidence of low postoperative cardiac output. The incidence of all other perioperative complications did not differ between the groups. The results of this study support the use of mammary grafts even in patients who are likely to need repeat coronary artery bypass grafting and certainly does not disqualify such patients from a 2nd operation.
为了评估再次冠状动脉搭桥术中使用胸廓内动脉搭桥的潜在风险，我们回顾了1991年1月1日至1993年12月31日期间连续接受再次冠状动脉搭桥术的233例患者的记录，其中包括209例胸廓内动脉移植血管闭塞或未进行胸廓内动脉移植的患者（第一组）和24例胸廓内动脉移植血管通畅的患者（第二组）。关于术前患者特征，两组之间唯一显著的差异是：第二组患者术前左心室射血分数高于第一组患者（63.7%±8.9%对52.1%±10.1%，p<0.001）；第二组患者每人接受的移植血管数量少于第一组患者（每人2.2±1.1根对3.6±1.4根，p<0.001）。两组均未发生移植血管或心脏的进入性损伤。第二组未出现围手术期死亡，而第一组有11例患者死亡（p<0.05）。第二组术后出血再次探查的发生率显著更高，而第一组术后低心排血量的发生率显著更高。两组间所有其他围手术期并发症的发生率无差异。本研究结果支持即使在可能需要再次冠状动脉搭桥术的患者中使用胸廓内动脉移植血管，并且肯定不排除此类患者进行二次手术。
