Holubkov R, Zenati M, Akin J J, Erb L, Courcoulas A
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S25-30. doi: 10.1016/s1010-7940(98)00100-6.
The CardioThoracic Systems (CTS) registry of minimally invasive direct coronary artery bypass (MIDCAB) was established to examine baseline characteristics of patients undergoing this surgical procedure, document details of the procedures including grafting techniques and post-operative complication rates, and assess post-operative graft patency.
A total of 508 consecutive patients who had MIDCAB using CTS instrumentation between April 1996 and March 1997 at 35 international centers were analyzed.
The mean age of patients, 27% of whom were women, was 63 years. Eight percent had previous coronary artery bypass surgery. While nearly all patients had significant stenoses in the left anterior descending artery, 23% had disease in two vessels and 9% in three vessels. Almost all procedures used the left internal mammary artery, with 7% employing multiple or sequential grafts. The entire surgical procedure lasted on average 135 min (median 2 h), with a mean time of 14 min to perform anastomosis. Surgical approaches, including anastomosis technique and method used to maintain bloodless field, varied widely across clinical centers. In-hospital complication rates were relatively low, with 0.6% mortality (0% perioperative), 1.2% conversion to sternotomy with cardiopulmonary bypass, 1.4% conversion to sternotomy without bypass, and 5.5% redo or reintervention. In total, 92% of patients were free from all of these events at hospital discharge; women showed a strong trend toward increased risk for major in-hospital events compared with men. Rib fracture was the most common complication, reported in 12% of patients. Post-operative angiography, performed in 83 patients at an average 2.2 days post-procedure, found full patency in 78 (94%).
The CTS registry data indicates that in the great majority of patients, MIDCAB using CTS instrumentation was performed safely and with acute success. Comparative studies, most importantly clinical trials, are needed to determine the types of patients who benefit most from this procedure, as well as its longer-term outcome.
建立心胸系统（CTS）微创直接冠状动脉旁路移植术（MIDCAB）登记系统，以研究接受该手术患者的基线特征，记录手术细节，包括移植技术和术后并发症发生率，并评估术后移植血管通畅情况。
分析了1996年4月至1997年3月期间在35个国际中心使用CTS器械进行MIDCAB的508例连续患者。
患者的平均年龄为63岁，其中27%为女性。8%的患者曾接受过冠状动脉旁路移植手术。几乎所有患者的左前降支均有明显狭窄，23%的患者累及两支血管，9%的患者累及三支血管。几乎所有手术都使用了左乳内动脉，7%的手术采用了多支或序贯移植。整个手术平均持续135分钟（中位数2小时），平均吻合时间为14分钟。不同临床中心的手术入路，包括吻合技术和用于维持术野无血的方法差异很大。住院并发症发生率相对较低，死亡率为0.6%（围手术期为0%），1.2%的患者转为体外循环下胸骨切开术，1.4%的患者转为非体外循环下胸骨切开术，5.5%的患者进行再次手术或再次干预。出院时，92%的患者未发生上述所有事件；与男性相比，女性发生主要住院事件的风险有增加的强烈趋势。肋骨骨折是最常见的并发症，12%的患者有此报告。83例患者术后平均2.2天进行了血管造影，发现78例（94%）移植血管完全通畅。
CTS登记系统的数据表明，在绝大多数患者中，使用CTS器械进行MIDCAB手术安全且即刻成功率高。需要进行比较研究，最重要的是临床试验，以确定从该手术中获益最大的患者类型及其长期预后。
