经左前外侧小切口获取双乳内动脉结合“分站式”杂交技术治疗冠状动脉多支病变65例

2-staged hybrid coronary revascularization using a bilateral internal thoracic artery Y graft for 65 patients with multivessel coronary artery disease

目的:探讨应用双乳内动脉(BITA)经左前外侧小切口实施"分站式"冠状动脉(冠脉)血运杂交重建术(HCR)治疗冠脉多支血管病变的可行性及安全性。方法:回顾性分析2014-05-2017-05我院应用BITA经左前外侧小切口实施HCR治疗的65例冠脉多支病变患者临床资料。分析患者手术情况及随访结果。结果:65例患者均顺利应用BITA经左前外侧小切口实施"分站式"HCR,全组无手术死亡。小切口冠脉旁路移植术(MIDCAB)的外科手术时间为(204.6±28.7)min,冠脉搭桥数(2.6±0.5)支,术后总引流量(520.1±120.3)ml,输红细胞5例(7.7%),机械通气时间(10.5±5.0)h,MIDCAB与PCI间隔时间(6.0±1.37)d。PCI前复查冠脉造影未见桥血管吻合口狭窄、闭塞情况,PCI植入支架(1.90±0.67)枚。术后平均随访1个月,65例患者无死亡、心绞痛、心肌梗死和脑卒中发生。结论:应用BITA经左前外侧小切口实施"分站式"HCR技术治疗多支冠脉病变早期临床结果显示可行性和安全性满意,远期疗效尚待进一步观察。

Objective：To observe early clinical outcomes of 2-staged hybrid coronary revascularization（HCR）using bilateral internal thoracic artery（BITA）for the treatment of multivessel coronary artery disease.Method：A total of 65 patients who underwent 2-staged HCR using BITAs in our hospital because of coronary multivessel lesions from May 2014 to May 2017 were included.The operation data and follow-up results were analyzed.Result：BITA operations were successfully harvested in 65 cases,and the mean operative time of minimally invasive direct coronary artery bypass（MIDCAB）were（204.6±28.7）min.The average number of grafts was（2.2±0.5）.The duration of mechanical ventilation and length of stay in ICU was（10.5±5.0）h and（16.4±6.4）h respectively.The average number of stent was 1.90±0.67,and 24-hours drainage during hospitalization was（520.1±120.3）ml.No occlusion of anastomosis was found,and no death,angina or myocardial infarction occurred in all 65 patients during the 1-month follow-up period.Conclusion：The 2-staged hybrid procedure using BITAs is safe and feasible for performing the multiple coronary artery revascularization in the short term,the long-term effect remains to be further observed.