183例动脉心肌血运重建术的中期随访

Mid-term follow-up of 183 arterial myocardial revascularization procedures.

作者信息

Antona C, Zanobini M, Lotto A A, Parolari A, Alamanni F, Biglioli P

机构信息

Department of Cardiac Surgery, Centro Cardiologico Fondazione I Monzino IRCCS, University of Milan, Italy.

出版信息

Eur J Cardiothorac Surg. 1997 Jan;11(1):140-8. doi: 10.1016/s1010-7940(96)01075-5.

DOI:10.1016/s1010-7940(96)01075-5

PMID:9030803

Abstract

OBJECTIVE

To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits.

METHODS

From July 1987 to December 1994, 183 patients underwent a myocardial revascularization procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at our institute. Their mean age was 56 +/- 8.7 years, the redo-operation rate was 16.9% (31/183), two-vessel disease was present in 61 patients (33.3%), three-vessel disease in 122 (66.7%).

RESULTS

The LIMA was used in 179 patients (97.8%), the RIMA in 116 (63.4%), the rGEA in 66 (36.1%) and the IEA in 41 (22.4%). In-hospital mortality was 1.1% (2/183), while the perioperative myocardial infarction (MI) rate was 2.2% (4/183). The angiographic restudy, performed on 87 (47.5%) patients during the early postoperative period (median 38 days) showed the following grafts patency rates: LIMA 98.8 (86/87), RIMA 97.1 (34/35), IEA 85.7 (24/28), rGEA 97.05 (33/34) and saphenous vein 90.9% (10/11). The median follow-up was 35 months. Kaplan-Meier survival was 96 +/- 2% at 3 and 5 years, freedom from angina 94 +/- 2% at 3 years and 91 +/- 3% at 5 years, while the Kaplan-Meier freedom from cardiac events was 90 +/- 3% at 3 years and 88 +/- 3% at 5 years. Cox regression analysis identified perioperative MI (P = 0.03, relative risk 3.6) as the only prognostic factor for mortality at follow-up. With regards to recurrence of angina, multivariate analysis has shown that incremental risk factors for the return of angina are redo-operation (P < 0.01, relative risk 2.7) and the persistence of hypertension after surgery (P < 0.01; relative risk 3.2), while the use of the RIMA in the operation has emerged as a protective factor (P = 0.02; relative risk 0.43). Finally, only redo-operation (P < 0.01; relative risk 2.3), has emerged as a predictor of cardiac complications.

CONCLUSION

Myocardial revascularization with at least two arterial grafts can be performed with very low perioperative morbidity and mortality and good mid-term follow-up. The mid-term results of arterial myocardial revascularization are less favourable in cases of redo-operations or when the RIMA is not used.

摘要

目的

评估采用动脉血管进行完全动脉化心肌血运重建的中期结果。

方法

1987年7月至1994年12月，我院183例患者接受了心肌血运重建手术，术中至少使用了两根动脉移植物（胸廓内动脉、桡动脉、胃网膜右动脉）。患者平均年龄56±8.7岁，再次手术率为16.9%（31/183），61例（33.3%）为双支血管病变，122例（66.7%）为三支血管病变。

结果

179例（97.8%）患者使用了左胸廓内动脉，116例（63.4%）使用了右胸廓内动脉，66例（36.1%）使用了桡动脉，41例（22.4%）使用了胃网膜右动脉。住院死亡率为1.1%（2/183），围手术期心肌梗死（MI）发生率为2.2%（4/183）。术后早期（中位时间38天）对87例（47.5%）患者进行的血管造影复查显示，各移植物通畅率如下：左胸廓内动脉98.8%（86/87），右胸廓内动脉97.1%（34/35），胃网膜右动脉85.7%（24/28），桡动脉97.05%（33/34），大隐静脉90.9%（10/11）。中位随访时间为35个月。3年和5年时的Kaplan-Meier生存率分别为96±2%，3年时无心绞痛发生率为94±2%，5年时为91±3%，而3年时Kaplan-Meier无心脏事件发生率为90±3%，5年时为88±3%。Cox回归分析确定围手术期心肌梗死（P = 0.03，相对风险3.6）是随访期间死亡率的唯一预后因素。关于心绞痛复发，多因素分析表明，心绞痛复发的增量危险因素为再次手术（P < 0.01，相对风险2.7）和术后高血压持续存在（P < 0.01；相对风险3.2），而术中使用右胸廓内动脉则为保护因素（P = 0.02；相对风险0.43）。最后，只有再次手术（P < 0.01；相对风险2.3）是心脏并发症的预测因素。