术前CT评估左胸小切口冠状动脉旁路移植技术复杂性

Correlation Between Preoperative CT Analysis and Technique Complexity in Minimally Invasive Coronary Artery Bypass Surgery

目的评估术前胸部CT数据预测左胸小切口冠状动脉旁路移植手术(minimally invasive cardiac surgery-coronary artery bypass grafting,MICS CABG)操作复杂性的价值。方法分析2018年1月~2022年7月30例多支MICS CABG术前胸部CT数据,包括心尖-气管隆突线(apical-carina line,A-C线),升主动脉右缘与正中线连线距离(right aorta-middle line,R-M线),升主动脉前壁与胸骨后缘连线距离(top-aorta line,T-A线),升主动脉-主肺动脉上缘连线与水平线之间角度(aorta-pulmonary angle,A-P角),心尖与正中线之间连线(apical-middle line,A-M线)与左侧胸腔最大横径(left-thoracic line,L-T线)之间的比值即左侧心胸比(cardiothoracic ratio,CTR)。自制“MICS CABG技术操作者评估量表”,包括切口位置、乳内动脉显露、乳内动脉获取复杂程度、升主动脉显露效果、升主动脉操作难度、升主动脉近端吻合、前降支系统远端吻合、回旋支系统远端吻合、右冠状动脉系统远端吻合、止血与关胸10个条目,术者根据各条目难易程度进行评分,由易到难用1~10分表示。分析术前CT数据与MICS CABG技术操作者评估量表各条目评分之间的相关性。结果A-C线与“乳内动脉显露”(r=0.877,P<0.001)和“乳内动脉获取复杂程度”(r=0.872,P<0.001)具有高度相关性;T-A线与“升主动脉显露效果”(r=0.561,P=0.001)具有相关性;A-P角与“升主动脉显露效果”(r=-0.835,P<0.001)具有高度相关性,与“升主动脉操作难度”(r=-0.612,P<0.001)和“升主动脉近端吻合”(r=-0.598,P<0.001)具有相关性;A-M线与“回旋支系统远端吻合”(r=0.629,P<0.001)具有相关性;左侧CTR与“回旋支系统远端吻合”(r=0.923,P<0.001)和“右冠状动脉系统远端吻合”(r=0.782,P<0.001)具有高度相关性。结论术前CT数据可以帮助预测MICS CABG的技术复杂程度,建立完善、综合的术前影像分析系统有助于安全、有效地实施MICS CABG技术。

Objective To evaluate the predictive value of preoperative Computed Tomography(CT)data in minimally invasive cardiac surgery-coronary artery bypass grafting(MICS CABG).Methods From January 2018 to July 2022,30 patients whose CT data was analyzed preoperatively underwent MICS CABG procedure for the treatment of coronary artery disease.The operator filled“MICS CABG technical evaluation scale”for complexity score postoperatively.Data was analyzed to find out the correlation of score and CT parameter for each patient.CT parameters include apical-carina line(A-C line),right aorta-middle line(R-M line),top-aorta line(T-A line),aorta-pulmonary angle(A-P angle),apical-middle line(A-M line)and left thorax line(L-T line),together with the left cardiothoracic ratio.We developed MICS CABG Technical Evaluation Scale,including 10 items which were incision,exposure of LIMA,complexity for LIMA harvesting,exposure of ascending aorta,complexity of aortic manipulation,proximal anastomosis,distal anastomosis in left anterior descending system,distal anastomosis in left circumflex system,distal anastomosis in right coronary artery system,and hemostasis and wound closure.Score of each item ranges from 1 to 10 as the technique complexity evolved.Correlation of preoperative CT parameter with technique complexity score was analyzed.Results The A-C line showed high correlation with exposure of LIMA(r=0.877,P<0.001)and complexity for LIMA harvesting(r=0.872,P<0.001).The T-A line showed correlation with exposure of ascending aorta(r=0.561,P=0.001).The A-P angle showed correlation with complexity of aortic manipulation(r=-0.612,P<0.001)and proximal anastomosis(r=-0.598,P<0.001),as well as high correlation with exposure of ascending aorta(r=-0.835,P<0.001).The A-M line showed correlation with distal anastomosis in left circumflex system(r=0.629,P<0.001).The left cardiothoracic ratio showed high correlation with distal anastomosis in left circumflex(r=0.923,P<0.001)and right coronary artery system(r=0.782,P<0.001).Conclusions Preoperative CT data analysis shows predictive value in complexity of MICS CABG procedure.Comprehensive imaging system is helpful for performing safe and effective MICS CABG procedure.