Magovern J A, Benckart D H, Landreneau R J, Sakert T, Magovern G J
Division of Thoracic Surgery, Allegheny University Hospitals, Allegheny General, and Allegheny University of the Health Sciences, Pittsburgh, PA 15212, USA.
Ann Thorac Surg. 1998 Oct;66(4):1224-9. doi: 10.1016/s0003-4975(98)00808-x.
Minimally invasive direct coronary artery bypass grafting (MIDCABG) promises to reduce the morbidity of coronary bypass, but this has not been proved.
This retrospective study compares the morbidity, mortality, cost, and 6-month outcome of patients less than 80 years old undergoing elective left internal mammary artery to left anterior descending artery bypass grafting via MIDCABG (n = 60) or sternotomy (n = 55) between January 1995 and December 1996. There were no differences between the groups in mean age, sex distribution, or preoperative risk level. The left internal mammary artery was mobilized from the fifth costal cartilage to the subclavian artery in all patients. The anastomoses were done with a beating heart in the MIDCABG group and with cardioplegic arrest in the sternotomy group.
There were no operative deaths in either group. The MIDCABG patients had a lower transfusion incidence (10/60 [17%] versus 22/55 [40%]; p< or =0.02) and a shorter postoperative intubation time (2.1+/-4.2 versus 12.6+/-9 hours; p< or =0.0001). One patient in each group was reexplored for bleeding. Three sternotomy patients (3/55, 5%) required ventilatory support for greater than 48 hours, but no MIDCABG patient was ventilated for more than 24 hours. Median postoperative length of stay was 4 days for MIDCABG and 7 days for sternotomy. Estimated hospital costs were $11,200+/-3100 for MIDCABG and $15,600+/-4200 for CABG (p < 0.001). The reduced morbidity and cost of MIDCABG was found mostly in high-risk patients. At 6-month follow-up, 5 MIDCABG patients (5/60, 8%) had evidence of recurrent ischemia involving the left anterior descending artery, primarily the result of anastomotic stricture.
This analysis shows that MIDCABG reduces the initial morbidity and cost of coronary bypass, but some patients require subsequent reintervention. Long-term follow-up is needed before MIDCABG can be judged better than traditional bypass, but the initial results are promising, especially in high-risk patients.
微创直接冠状动脉旁路移植术（MIDCABG）有望降低冠状动脉旁路移植术的发病率，但尚未得到证实。
这项回顾性研究比较了1995年1月至1996年12月期间，年龄小于80岁、接受择期左乳内动脉至左前降支动脉旁路移植术的患者的发病率、死亡率、费用和6个月的预后情况。这些患者通过MIDCABG（n = 60）或胸骨切开术（n = 55）进行手术。两组患者在平均年龄、性别分布或术前风险水平方面无差异。所有患者的左乳内动脉均从第五肋软骨游离至锁骨下动脉。MIDCABG组在心脏跳动下进行吻合，胸骨切开术组在心脏停搏下进行吻合。
两组均无手术死亡病例。MIDCABG患者的输血发生率较低（10/60 [17%] 对22/55 [40%]；p≤0.02），术后插管时间较短（2.1±4.2对12.6±9小时；p≤0.0001）。每组各有1例患者因出血再次手术。3例胸骨切开术患者（3/55，5%）需要通气支持超过48小时，但没有MIDCABG患者通气超过24小时。MIDCABG术后中位住院时间为4天，胸骨切开术为7天。MIDCABG的估计住院费用为11200±3100美元，冠状动脉旁路移植术（CABG）为15600±4200美元（p < 0.001）。MIDCABG发病率和费用的降低主要见于高危患者。在6个月的随访中，5例MIDCABG患者（5/60，8%）有左前降支动脉复发性缺血的证据，主要是吻合口狭窄所致。
该分析表明，MIDCABG降低了冠状动脉旁路移植术的初始发病率和费用，但部分患者需要后续再次干预。在判定MIDCABG优于传统旁路移植术之前，需要进行长期随访，但初步结果很有前景，尤其是在高危患者中。
