Dion R, Etienne P Y, Verhelst R, Khoury G, Rubay J, Bettendorff P, Hanet C, Wyns W
Department of Cardiovascular and Thoracic Surgery, University Hospital St. Luc, Brussels, Belgium.
Eur J Cardiothorac Surg. 1993;7(6):287-93; discussion 294. doi: 10.1016/1010-7940(93)90169-c.
Between October 1985 and September 1991, 400 patients benefited from bilateral internal mammary artery (BIMA) grafting. Of these, 354 (88.5%) were male and the average age was 57.4 years. There were 132 (33%) urgent procedures, 55 in diabetic patients (14%) and 15 in end-stage renal failures (4%). An average of 3.9 distal anastomoses (AN) per patient was undertaken, 2.8 using arterial grafts. Two hundred sixty-nine patients (67.2%) received exclusively arterial grafts. Right internal mammary artery (RIMA) grafts were predominantly directed to the left coronary system (348 AN = 78%) and particularly to the circumflex (CX) area. Postoperative myocardial infarction was diagnosed in 16 patients (4%). Reoperation was required for early myocardial ischemia in 12 patients (3%) and for excessive bleeding in 23 patients (5.8%). Sternal complications occurred in 18 patients (4.1%), 5 in diabetic patients (9%) and 3 in renal patients (20%). The hospital mortality was 2% (8 patients, 3 cardiac causes). Follow-up averages 37.7 months. Late mortality was 3% (12 patients, 4 cardiac causes). Angina recurred in 12 patients (3.1%). The maximal stress test at a mean interval of 9 months was abnormal in 7.4% (21 patients). One hundred eighty-one patients (47%) consented to an angiographic restudy at an average of 13 months postoperatively. Pedicled RIMA patency rates equal those of pedicled LIMA (95.1 vs 96.7, NS) and the grafted vessel does not alter the patency rates of IMA AN. A pedicled IMA graft is preferable to a free IMA graft (96.1 vs 79.6, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
1985年10月至1991年9月期间，400例患者受益于双侧乳内动脉（BIMA）移植。其中，354例（88.5%）为男性，平均年龄为57.4岁。有132例（33%）为急诊手术，糖尿病患者55例（14%），终末期肾衰竭患者15例（4%）。每位患者平均进行3.9次远端吻合（AN），其中2.8次使用动脉移植物。269例患者（67.2%）仅接受动脉移植物。右乳内动脉（RIMA）移植物主要用于左冠状动脉系统（348次AN = 78%），特别是用于回旋支（CX）区域。16例患者（4%）术后被诊断为心肌梗死。12例患者（3%）因早期心肌缺血需要再次手术，23例患者（5.8%）因出血过多需要再次手术。18例患者（4.1%）发生胸骨并发症，糖尿病患者5例（9%），肾病患者3例（20%）。医院死亡率为2%（8例患者，3例死于心脏原因）。随访平均37.7个月。晚期死亡率为3%（12例患者，4例死于心脏原因）。12例患者（3.1%）心绞痛复发。平均间隔9个月时，最大应力测试异常的患者占7.4%（21例患者）。181例患者（47%）同意在术后平均13个月时进行血管造影复查。带蒂RIMA通畅率与带蒂LIMA相等（95.1对96.7，无显著性差异），且移植血管不改变IMA AN的通畅率。带蒂IMA移植物优于游离IMA移植物（96.1对79.6，P < 0.001）。（摘要截断于250字）
