Paolini G, Mariani M A, Benussi S, Zuccari M, Di Credico G, Gallorini C, Grossi A
Institute for Cardiovascular and Respiratory Diseases, University of Milan, Scientific Institute H. San Raffaele, Italy.
Eur J Cardiothorac Surg. 1993;7(2):91-5. doi: 10.1016/1010-7940(93)90187-g.
The superiority of the internal thoracic artery (ITA) compared with venous conduits in terms of late graft patency is nowadays well documented. The inferior epigastric artery (IEA) was recently proposed as an alternative conduit for coronary artery surgery with good early clinical and angiographic results. To improve the benefits from myocardial revascularization, we expanded the use of these arterial conduits. From June 1988 to December 1991, 615 patients underwent coronary surgery in our institute. In 138 of them (22.4%) we performed total arterial myocardial revascularization placing 2 or more coronary anastomoses. An average of 2.37 anastomoses per patient were placed with the maximum number of 6 in one case. Only one patient died of cardiac related causes (0.72%). Perioperative morbidity included myocardial infarction and sternal dehiscence in 5 patients each (3.6%). No stroke or reoperation for bleeding occurred. No rectus muscle necrosis was recorded. Accurate preoperative planning of graft placement allows for the performance of as many as 6 distal anastomoses using bilateral ITA and single IEA grafts only, thus completely revascularizing most of the hearts with three-vessel disease. In our series this procedure was not reflected in an increase in the perioperative morbidity. We choose an elective total arterial revascularization in younger (under 65 years) patients who, while showing a lower incidence of complications in our study, are likely to derive the highest benefits from the good durability of ITA and hopefully IEA grafts.
目前已有充分文献证明，在晚期移植物通畅方面，胸廓内动脉（ITA）优于静脉移植物。近来，腹壁下动脉（IEA）被提议作为冠状动脉手术的替代移植物，早期临床和血管造影结果良好。为提高心肌血运重建的益处，我们扩大了这些动脉移植物的应用。1988年6月至1991年12月，我院有615例患者接受了冠状动脉手术。其中138例（22.4%）进行了全动脉心肌血运重建，吻合了2处或更多冠状动脉。平均每位患者吻合2.37处，最多1例吻合了6处。仅1例患者死于心脏相关原因（0.72%）。围手术期并发症包括5例患者发生心肌梗死和胸骨裂开（各占3.6%）。未发生中风或因出血而再次手术的情况。未记录到腹直肌坏死。精确的术前移植物放置规划使得仅使用双侧ITA和单根IEA移植物就能进行多达6处远端吻合，从而使大多数三支血管病变的心脏完全实现血运重建。在我们的系列研究中，这一手术并未导致围手术期并发症增加。我们选择对年龄较轻（65岁以下）的患者进行择期全动脉血运重建，这些患者在我们的研究中并发症发生率较低，且可能从ITA以及有望从IEA移植物的良好耐久性中获得最大益处。
