个体化全动脉冠状动脉旁路移植术的临床应用
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摘要
目的:总结非体外循环下个体化全动脉冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的近期结果和手术经验。方法:2016年1月—2018年11月,55例冠脉多支病变患者接受了非体外循环下个体化全动脉CABG术。26例采用原位左乳内动脉和左桡动脉(47.3%)作为移植血管材料,16例采用原位左乳内动脉和双桡动脉(29.1%),11例使用原位左乳内动脉、游离右乳内动脉和左桡动脉(20.0%),余2例使用原位双乳内动脉和左桡动脉(3.6%)。观察患者围手术期并发症,随访移植血管通畅率,考察患者的生存质量。结果:有2例患者术后置入主动脉内球囊反搏(intra-aortic balloon pump,IABP)治疗,2例切口延迟愈合,1例急性肾衰,经积极治疗后均好转,围术期和随访过程中无死亡,无主要心脑血管不良事件发生,心绞痛症状全部消失,随访的移植血管全部通畅,无再次血运重建手术需要。结论:非体外循环下全动脉CABG近期临床疗效满意,基于个体靶血管解剖特点的个体化全动脉策略可实现完全再血管化,近期桥血管通畅率满意。
引文
[1] Khan AR,Golwala H,Tripathi A,et al. Meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting in left main coronary artery disease[J].Am J Cardiol,2017,119(12):1949-1956
[2] Di Bacco L,Repossini A,Tespili MA,et al. Long-term follow-up of total arterial versus conventional and hybrid myocardial revascularization:A propensity score matched analysis[J]. Cardiovasc Revasc Med,2019,20(1):22-28
[3] Yanagawa B,Verma S,Mazine A,et al. Impact of total arterial revascularization on long term survival:A systematic review and meta-analysis of 130,305 patients[J]. Int J Cardiol,2017,233:29-36
[4] Fleissner F,Engelke H,Rojas-Hernandez S,et al. Longterm follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts:survival,cardiac morbidity and quality of life[J]. Eur J Cardiothorac Surg,2016,49(4):1195-1200
[5] Kim MS,Hwang HY,Kim JS,et al. Saphenous vein versus right internal thoracic artery as a Y-composite graft:Five-year angiographic and clinical results of a randomized trial[J]. J Thorac Cardiovasc Surg,2018,156(4):1424
[6] Zacharias A,Habib RH,Schwann TA,et al. Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting[J]. Circulation,2004,109(12):1489-1496
[7] Iribarne A,Schmoker JD,Malenka DJ,et al.Does use of bilateral internal mammary artery grafting reduce longterm risk of repeat coronary revascularization?a multicenter analysis[J]. Circulation,2017,136(18):1676-1685
[8] Taggart DP,Altman DG,Flather M,et al. Associations between adding a radial artery graft to single and bilateral internal thoracic artery grafts and outcomes insights from the arterial revascularization trial[J]. Circulation,2017,136(5):454
[9] Mohite PN,Thingnam SK,Saxena AK. Radial artery compression in incomplete palmar arch for radial artery harvesting[J]. Asian Cardiovasc Thorac Ann,2014,22(4):416-420
[10] Drohomirecka A,Kwinecki P,Gwozdz WA,et al. Forearm and hand function after radial artery harvest for coronary artery bypass grafting:subjective patients’assessment[J]. Heart Surg Forum,2016,19(4):E198-E202
[11]刘博,王其逊,粟家元,等. 2型糖尿病对于非体外循环冠状动脉旁路移植术患者术后急性肾损伤等并发症的影响[J].南京医科大学学报(自然科学版),2018,38(8):1089-1094
[12]Taggart DP,Altman DG,Gray AM,et al. Randomized trial of bilateral versus single Internal-Thoracic-Artery grafts[J]. N Engl J Med,2016,375(26):2540-2549
[13]Hu YR,Yang XB,Zhang L,et al. Perioperative diltiazem or nitroglycerin in on-pump coronary artery bypass:a systematic review and network meta-analysis[J]. PLoS One,2018,13(8):e0203315
[14]Dimitrova KR,Hoffman DM,Geller CM,et al. Arterial grafts protect the native coronary vessels from atherosclerotic disease progression[J]. Ann Thorac Surg,2012,94(2):475-481
[15]Harskamp RE,Lopes RD,Baisden CE,et al. Saphenous vein graft failure after coronary artery bypass surgery pathophysiology,management,and future directions[J].Ann Surg,2013,257(5):824-833
[16]De Vries MR,Simons KH,Jukema J,et al. Vein graft failure:from pathophysiology to clinical outcomes[J]. Nat Rev Cardiol,2016,13(8):451-470
[17] Gaudino M,Tondi P,Benedetto U,et al. Radial artery as a coronary artery bypass conduit:20-year results[J]. J Am Coll Cardiol,2016,68(6):603-610
[18] Yadava O P,Sharma V,Prakash A,et al. Correlation between Doppler,manual morphometry,and histopathology based morphometry of radial artery as a conduit in coronary artery bypass grafting[J]. Cardiol Re Pract,2016,2016:8047340
[19]Alderman EL,Kip KE,Whitlow PL,et al. Native coronary disease progression exceeds failed revascularization as cause of angina after five years in the Bypass Angioplasty Revascularization Investigation(BARI)[J]. Am Coll Cardiol,2004,44(4):766-774
[20]Kereiakes DJ. Reassessing the importance of complete versus incomplete coronary revascularization[J]. Rev Cardiovasc Med,2014,15(1):24-30
[2] Di Bacco L,Repossini A,Tespili MA,et al. Long-term follow-up of total arterial versus conventional and hybrid myocardial revascularization:A propensity score matched analysis[J]. Cardiovasc Revasc Med,2019,20(1):22-28
[3] Yanagawa B,Verma S,Mazine A,et al. Impact of total arterial revascularization on long term survival:A systematic review and meta-analysis of 130,305 patients[J]. Int J Cardiol,2017,233:29-36
[4] Fleissner F,Engelke H,Rojas-Hernandez S,et al. Longterm follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts:survival,cardiac morbidity and quality of life[J]. Eur J Cardiothorac Surg,2016,49(4):1195-1200
[5] Kim MS,Hwang HY,Kim JS,et al. Saphenous vein versus right internal thoracic artery as a Y-composite graft:Five-year angiographic and clinical results of a randomized trial[J]. J Thorac Cardiovasc Surg,2018,156(4):1424
[6] Zacharias A,Habib RH,Schwann TA,et al. Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting[J]. Circulation,2004,109(12):1489-1496
[7] Iribarne A,Schmoker JD,Malenka DJ,et al.Does use of bilateral internal mammary artery grafting reduce longterm risk of repeat coronary revascularization?a multicenter analysis[J]. Circulation,2017,136(18):1676-1685
[8] Taggart DP,Altman DG,Flather M,et al. Associations between adding a radial artery graft to single and bilateral internal thoracic artery grafts and outcomes insights from the arterial revascularization trial[J]. Circulation,2017,136(5):454
[9] Mohite PN,Thingnam SK,Saxena AK. Radial artery compression in incomplete palmar arch for radial artery harvesting[J]. Asian Cardiovasc Thorac Ann,2014,22(4):416-420
[10] Drohomirecka A,Kwinecki P,Gwozdz WA,et al. Forearm and hand function after radial artery harvest for coronary artery bypass grafting:subjective patients’assessment[J]. Heart Surg Forum,2016,19(4):E198-E202
[11]刘博,王其逊,粟家元,等. 2型糖尿病对于非体外循环冠状动脉旁路移植术患者术后急性肾损伤等并发症的影响[J].南京医科大学学报(自然科学版),2018,38(8):1089-1094
[12]Taggart DP,Altman DG,Gray AM,et al. Randomized trial of bilateral versus single Internal-Thoracic-Artery grafts[J]. N Engl J Med,2016,375(26):2540-2549
[13]Hu YR,Yang XB,Zhang L,et al. Perioperative diltiazem or nitroglycerin in on-pump coronary artery bypass:a systematic review and network meta-analysis[J]. PLoS One,2018,13(8):e0203315
[14]Dimitrova KR,Hoffman DM,Geller CM,et al. Arterial grafts protect the native coronary vessels from atherosclerotic disease progression[J]. Ann Thorac Surg,2012,94(2):475-481
[15]Harskamp RE,Lopes RD,Baisden CE,et al. Saphenous vein graft failure after coronary artery bypass surgery pathophysiology,management,and future directions[J].Ann Surg,2013,257(5):824-833
[16]De Vries MR,Simons KH,Jukema J,et al. Vein graft failure:from pathophysiology to clinical outcomes[J]. Nat Rev Cardiol,2016,13(8):451-470
[17] Gaudino M,Tondi P,Benedetto U,et al. Radial artery as a coronary artery bypass conduit:20-year results[J]. J Am Coll Cardiol,2016,68(6):603-610
[18] Yadava O P,Sharma V,Prakash A,et al. Correlation between Doppler,manual morphometry,and histopathology based morphometry of radial artery as a conduit in coronary artery bypass grafting[J]. Cardiol Re Pract,2016,2016:8047340
[19]Alderman EL,Kip KE,Whitlow PL,et al. Native coronary disease progression exceeds failed revascularization as cause of angina after five years in the Bypass Angioplasty Revascularization Investigation(BARI)[J]. Am Coll Cardiol,2004,44(4):766-774
[20]Kereiakes DJ. Reassessing the importance of complete versus incomplete coronary revascularization[J]. Rev Cardiovasc Med,2014,15(1):24-30