HCR与MICS-CABG在低射血分数非糖尿病冠心病患者的早中期疗效回顾性队列研究

Retrospective cohort study of early and mid-term results of HCR and MICS-CABG in coronary artery disease patients with low ejection fraction and non diabetes mellitus

目的探讨杂交冠状动脉再血管化(HCR)与微创多支冠状动脉旁路移植术(MICS-CABG)在低射血分数非糖尿病冠心病多支血管病变患者的早、中期疗效及适应证。方法回顾性分析2015年1月至2019年12月期间在西京医院心血管外科完成的53例左心室射血分数(LVEF)低于0.40,且不合并糖尿病的HCR与MICS-CABG病例,其中36例接受了分站式HCR治疗(HCR组),17例接受了MICS-CABG多支血管旁路移植术(MICS组)。HCR组患者先行左侧肋间小切口左乳内动脉(LIMA)至左前降支(LAD)旁路移植术,1~4周后行经皮冠状动脉介入(PCI)治疗LAD以外的冠状动脉病变;MICS-CABG组患者经左侧肋间小切口行多支病变血管微创冠状动脉旁路移植术。结果MICS组SYNTAX评分显著高于HCR组,组间差异有统计学意义(P<0.05)。两组均无围手术期死亡。MICS组术后24 h肌钙蛋白I、胸腔引流量、输血量和呼吸机通气时间显著高于HCR组,组间差异有统计学意义(P<0.05)。术后随访12个月,两组均无患者死亡,LIMA-LAD移植血管均通畅;且LVEF、左心室舒张末期内径均比术前显著改善,差异有统计学意义(P<0.05)。结论对于低射血分数的非糖尿病冠心病多支血管病变患者,HCR与MICS-CABG均为微创、安全的治疗手段,早、中期疗效满意。如果LAD以外的血管病变适合PCI治疗,HCR应为首选治疗方式。

Objective To compare the early and mid-term results of hybrid coronary revascularization(HCR)and minimally invasive multivessel coronary artery bypass grafting(MICS-CABG)in coronary artery disease patients with low left ventricular ejection fraction and non diabetes mellitus,and to explore the indication of HCR and MICS-CABG.Methods A retrospective cohort analysis of HCR and MICS-CABG cases with preoperative left ventricular ejection fraction less than 0.40,and without diabetes mellitus were conducted in Xijing Hospital from January 2015 to December 2019.36 cases in HCR group and 17 cases in MICS group were included in this study.For HCR procedure,minimally invasive left internal mammary artery(LIMA)to the left anterior descending artery(LAD)bypass surgery were performed,and followed by percutaneous coronary intervention(PCI)to treat non LAD lesion 1 to 4 weeks later.MICS-CABG procedure was performed through left anterior small thoracotomy minimally invasive direct coronary artery bypass grafting for multiple diseased vessels.Results The preoperative SYNTAX score in MICS group was significantly higher than that in HCR group(P<0.05).There was no perioperative death in both groups.Troponin I,postoperative drainage volume,blood transfusion volume and ventilator ventilation time in MICS group were significantly higher than those in HCR group(P<0.05).After 12 months follow-up,no patient died in both groups.Furthermore,all LIMA grafts were patency.The stenosis rate of drug-eluting stents in HCR group was similar to that of great saphenous vein grafts in MICS group.LVEF and left ventricular end diastolic diameter of both groups were significantly improved 12 months after operation(P<0.05).Conclusion HCR and MICS-CABG are minimally invasive and safe treatment for multivessel coronary artery disease patients with low ejection fraction and non diabetese mellitus.The early and mid-term therapeutic effects are satisfactory.If coronary artery lesions other than LAD are suitable for PCI,HCR should be the preferred treatment.