Bical O, Braunberger E, Fischer M, Robinault J, Foiret J C, Fromes Y, Gaillard D, Maribas P, Bouharaoua T, Souffrant G, Vanetti A
Department of Cardiac Surgery, Hôpital Saint Joseph, Paris, France.
Eur J Cardiothorac Surg. 1996;10(11):971-5; discussion 976. doi: 10.1016/s1010-7940(96)80399-x.
To test the hypothesis that the skeletonized technique of harvesting the internal thoracic artery improves the surgical results of bilateral internal thoracic artery grafting, we reviewed our 7-year experience with this technique.
Between July 1987 and December 1994, 560 patients received bilateral internal thoracic artery grafts and 236 additional grafts (average 2.6 +/- 0.6 anastomoses per patient). There were 515 men (92%) and the average age was 56.9 +/- 8.8 years. There were 63 diabetic patients (11.3%). During harvesting, the internal thoracic arteries were always totally skeletonized from the surrounding tissues without the use of electrocautery.
Postoperative complications included reoperation for bleeding, 17 patients (3%), phrenic nerve paresis, 17 patients (3%), acute respiratory distress syndrome, 9 patients (1.6%), digestive complications, 8 patients (1.4%), neurologic complications, 6 patients (1.1%), and sternal complications, 6 patients (1.1%). No wound complications were observed in diabetic patients. The hospital mortality rate was 1.6% (9 patients, 2 cardiac causes). The early patency of internal thoracic artery grafts was 97.9%. Follow-up averages 29 +/- 20 months. There were 14 late deaths (4 cardiac causes). Angina recurred in 51 patients and the maximal stress test was abnormal in 47 patients.
Bilateral internal thoracic artery grafting with skeletonized harvesting carried low post-operative mortality and morbidity and therefore it could be applied routinely without the fear of increased complication rate.
为验证胸廓内动脉骨骼化采集技术可改善双侧胸廓内动脉搭桥手术效果这一假说，我们回顾了应用该技术7年的经验。
1987年7月至1994年12月期间，560例患者接受了双侧胸廓内动脉搭桥术，共进行了236次额外搭桥（平均每位患者2.6±0.6个吻合口）。男性515例（92%），平均年龄56.9±8.8岁。糖尿病患者63例（11.3%）。采集过程中，胸廓内动脉始终完全从周围组织中骨骼化游离出来，未使用电灼术。
术后并发症包括因出血再次手术17例（3%）、膈神经麻痹17例（3%）、急性呼吸窘迫综合征9例（1.6%）、消化系统并发症8例（1.4%）、神经系统并发症6例（1.1%）以及胸骨并发症6例（1.1%）。糖尿病患者未观察到伤口并发症。医院死亡率为1.6%（9例，2例因心脏原因）。胸廓内动脉搭桥的早期通畅率为97.9%。随访平均29±20个月。有14例晚期死亡（4例因心脏原因）。51例患者心绞痛复发，47例患者最大负荷试验异常。
采用骨骼化采集技术的双侧胸廓内动脉搭桥术术后死亡率和发病率较低，因此可常规应用，无需担心并发症发生率增加。
