Bauer E P, Schönburg M, Schwarz T, Piepho A, Klövekorn W P
Max-Planck-Institute for Clinical and Physiological Research, Kerckhoff Clinic, Bad Nauheim, Germany.
Eur J Cardiothorac Surg. 1996;10(4):248-52. doi: 10.1016/s1010-7940(96)80147-3.
The internal mammary artery (IMA) provides better early and long-term patency than venous grafts do. Although IMA is the conduit of choice in isolated coronary artery bypass grafting (CABG), its use in combined procedures is not routine in some cardiovascular units. During a 16-month period, 188 patients underwent valve surgery combined with CABG. Internal mammary grafts were used in 68/188 (36%) patients (group 1) and vein grafts without arterial grafts (group 2) in 120/188 (64%). Left IMA was implanted in 67/68 (99%) and right IMA in 1/68 1%) cases. Surgeon A used IMA in 28/44 (64%), surgeon B in 20/32 (63%), surgeon C in 18/44 (41%), surgeon D in 1/4 (25%) and surgeon E in 1/63 (2%) patients. The final decision to use IMA in a combined procedure was left up to the surgeon. Statistically, the preoperative- and perioperative data were identical in the two groups, although the frequency of IMA grafting in patients with double valve replacement and reoperation was lower (1/68 vs 11/120, ns, and 3/68 vs 9/120, ns). Ten of 188 (5.3%) patients died within 30 days after operation. Longer cross-clamp time (P = 0.008) and mitral valve replacement (P = 0.05) were independent risk factors for early death. The use of IMA did not increase the risk of early mortality. The postoperative variables were similar in the IMA and vein groups, in particular data suggesting perioperative myocardial infarction (CK-MB, catecholamine support). Postoperative mechanical ventilation was longer in the IMA group, although not significantly (P = 0.06). Early mortality and morbidity were identical in the two groups in combined procedures. We did not find any hints for an increased risk of using IMA in this type of surgery. Internal mammary artery implantation is safe in selected patients undergoing combined valve and CABG surgery. Beside the better long-term patency of IMA, its use may have several technical advantages.
与静脉移植物相比，乳内动脉（IMA）具有更好的早期和长期通畅性。尽管IMA是孤立冠状动脉旁路移植术（CABG）中首选的血管 conduit，但在一些心血管科室，其在联合手术中的应用并不常规。在16个月期间，188例患者接受了瓣膜手术联合CABG。188例患者中有68例（36%）使用了乳内动脉移植物（第1组），120例（64%）使用了无动脉移植物的静脉移植物（第2组）。68例中67例（99%）植入了左IMA，1例（1%）植入了右IMA。外科医生A在44例中的28例（64%）使用了IMA，外科医生B在32例中的20例（63%），外科医生C在44例中的18例（41%），外科医生D在4例中的1例（25%），外科医生E在63例中的1例（2%）使用了IMA。在联合手术中使用IMA的最终决定由外科医生做出。从统计学上看，两组的术前和围手术期数据相同，尽管双瓣膜置换和再次手术患者中IMA移植的频率较低（1/68对11/120，无统计学意义，3/68对9/120，无统计学意义）。188例患者中有10例（5.3%）在术后30天内死亡。较长的阻断时间（P = 0.008）和二尖瓣置换（P = 0.05）是早期死亡的独立危险因素。使用IMA并未增加早期死亡风险。IMA组和静脉组的术后变量相似，特别是提示围手术期心肌梗死的数据（CK-MB、儿茶酚胺支持情况）。IMA组术后机械通气时间较长，尽管无显著差异（P = 0.06）。联合手术中两组的早期死亡率和发病率相同。我们未发现此类手术中使用IMA会增加风险的任何迹象。在选定的接受瓣膜手术联合CABG的患者中，植入乳内动脉是安全的。除了IMA具有更好的长期通畅性外，其使用可能还有一些技术优势。
