Bical O, Aznag H, Weber S, Py A, Fischer M, Maribas P, Souffrant G, Vanetti A
Service de chirurgie cardiaque et thoracique, hôpital Saint-Joseph, Paris.
Arch Mal Coeur Vaiss. 1993 Apr;86(4):423-6.
Forty-nine patients who had coronary artery reoperations were divided into two groups: the 29 patients of the first group were operated conventionally with use of one internal mammary artery or a saphenous vein; the 20 patients of the second group were reoperated using both internal mammary arteries. Three patients (6%) died prematurely: two in the first and one in the second group. The rates of peri-operative infarction were 7% and 15% respectively. The average postoperative bleeding was 472 +/- 385 ml in the first group and 700 +/- 628 ml in the second group (NS). All patients are pauci-symptomatic and have a negative exercise stress test. The mortality and morbidity of coronary reoperation does not seem to be greater with double internal mammary artery bypass grafting. However, this technique should be reserved for patients who can derive long-term benefit from reoperation with arterial grafts, that is to say in patients in good clinical condition, less than 65 years of age with good left ventricular function. In these patients, double internal mammary artery bypass grafting may avoid a third operation for myocardial revascularisation.
49例行冠状动脉再次手术的患者被分为两组：第一组29例患者采用一根胸廓内动脉或大隐静脉进行传统手术；第二组20例患者采用双侧胸廓内动脉进行再次手术。3例患者（6%）过早死亡：第一组2例，第二组1例。围手术期梗死发生率分别为7%和15%。第一组术后平均出血量为472±385 ml，第二组为700±628 ml（无显著性差异）。所有患者症状轻微，运动负荷试验阴性。双侧胸廓内动脉搭桥术的冠状动脉再次手术的死亡率和发病率似乎并不更高。然而，这项技术应保留给那些能从动脉移植再次手术中获得长期益处的患者，也就是说，临床状况良好、年龄小于65岁且左心室功能良好的患者。在这些患者中，双侧胸廓内动脉搭桥术可能避免第三次心肌血运重建手术。
