乳内动脉-大隐静脉复合桥血管在老年人非体外循环冠状动脉旁路移植术中的应用及中期随访结果

Mid-term Outcomes of Left Internal Mammary Artery to Saphenous Vein Composite Grafts in Off-pump Coronary Artery Bypass Surgery for Elderly Patients

目的探讨乳内动脉-大隐静脉复合桥血管在老年患者非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass surgery,OPCAB）中的应用及治疗效果。方法 2006年3月至2012年10月,新华医院心胸外科在OPCAB中应用左乳内动脉（left internal mammary artery,LIMA）-动脉或静脉复合桥血管治疗老年（70岁以上）冠心病患者共59例,其中男37例、女22例,平均年龄（72.71±1.95）岁。其中动脉-大隐静脉（SV）复合桥血管（LIMA-SV）组21例,动脉-桡动脉（RA）复合桥血管（LIMA-RA）组38例。结果所有患者均顺利应用LIMA-SV或LIMA-RA复合桥血管行OPCAB术。术后早期,LIMA-RA组死亡1例,其余58例均顺利康复出院,两组患者术后早期恢复情况差异无统计学意义（P〉0.05）。术后随访12~91个月,无冠状动脉再血管化病例。两组术后1年、3年、5年的累积生存率差异无统计学意义（P〉0.05）。全组患者LIMA通畅率为100%;术后1年、3年、5年SV桥血管通畅率与RA桥血管通畅率差异无统计学意义（P〉0.05）。结论尽管全动脉化是最佳的桥血管选择方案,但对于右乳内动脉或桡动脉桥无法使用,或获取后并发症风险较高的老年患者,LIMA-SV复合桥血管方案仍是一种良好的选择。

Objective To explore the mid-term outcomes achieved by using the left internal mammary artery to saphenous vein composite grafts in off-pump coronary artery bypass surgery（OPCAB） for elderly patients. Methods A total of 59 elderly patients（≥70 years old） underwent OPCAB by using left internal mammary artery（LIMA） to radial artery（RA） or saphenous vein（SV） composite grafts in Xinhua Hospital between March 2006 and October 2012. There was 37 males and 22 females at age of 72.71±1.95 years. Twenty one patients used LIMA-SV composite grafts（LIMA-SV group）, and 38 patients used LIMA-RA composite grafts（LIMA-RA group）. Results All patients successfully underwent OPCAB with LIMA-SV or LIMA-RA composite grafts. There was one early death in the LIMA-RA group. No statistical differences in early postoperative outcomes were found between the two groups（P〉0.05）. During a follow-up of 12 to 91 months, no patient occurred revascularization. There were no statistical differences in overall survival or graft patency rate, and 1 year, 3 years or 5 years survival rates between the two groups（P〉0.05）. The patency rate of LIMA in each group was 100% respectively. There was also no statistical difference in overall patency rate of SV and RA between the two groups at the end of 1 year, 3 years or 5 years（P〉0.05）. Conclusion Although artery grafts are the best choice for OPCAB, LIMA-SV composite grafts can be used as an alternative graft for elderly patients whose RA or right internal mammary artery is not possible or advisable.