冠状动脉旁路移植术中应用右侧乳内动脉的单中心研究

Single-center usage of right internal mammary artery in coronary artery bypass grafting

目的总结冠状动脉旁路移植术(CABG)中右侧乳内动脉(RIMA)的使用情况,分析RIMA使用的目的、方式和结果。方法回顾性收集2016年1月1日至2021年10月31日期间在北京大学人民医院心外科行CABG术患者的临床资料,按是否应用RIMA分为RIMA组和非RIMA组,对两组患者按1∶1行倾向性匹配,比较手术结果,分析RIMA应用情况。结果共完成CABG术1537例,其中128例应用RIMA。经倾向性评分匹配后,RIMA组(128例)与非RIMA组(128例)患者的基线数据差异无统计学意义(P>0.05)。RIMA组旁路移植血管数[(2.81±0.91)支/例对(2.40±1.26)支/例,P=0.005]和动脉旁路移植血管数[(2.10±0.65)支/例对(0.99±0.43)支/例,P<0.001]均高于非RIMA组,静脉旁路血管移植数少于非RIMA组[(0.71±0.90)支/例对(1.41±1.35)支/例,P<0.001]。RIMA组术后胸腔引流量多于非RIMA组[(1068.45±494.02)ml对(888.02±422.67)ml,P=0.002]。两组的术后呼吸机时间、住监护室时间及并发症发生率差异无统计学意义(P>0.05)。RIMA旁路移植血管术后通畅率95.2%(99/104)。RIMA靶血管为左前降支(45例)、对角支(19例)、中间支(12例)、钝缘或回旋支(16例)、后降支(5例)、右冠状动脉主干(18例);序贯吻合13例。RIMA游离移植41例,原位应用87例,需其他旁路血管材料延长使用19例。结论在CABG中,RIMA旁路血管术后通畅率较高,应用RIMA未明显增加手术风险,其使用方式变化较大,可选择性应用。

Objective To report the use of right internal mammary artery(RIMA)in coronary artery bypass grafting(CABG)in our center,summarize the purpose and configuration of RIMA graft in CABG.Methods All clinical data of coronary artery bypass grafting patients in our center performed in the past 6 years were collected and analyzed retrospectively.Those patients were divided into RIMA group and non-RIMA group according to the use of RIMA.Propensity score matching had been performed before these data was compared.Surgical technique of use of RIMA was summarized.Results 1537 CABG had been performed from January 1st,2016 to October 31st,2021 in our center.Of which,128 cases were allocated to RIMA group.After propensity score matching having been performed,there was no difference in baseline data between the RIMA group and the non-RIMA group(128 cases),and the RIMA group had more grafts and arterial grafts than the non-RIMA group.The postoperative drainage volume in the RIMA group was more than that of the non-RIMA group.However,there was no statistical significance in difference of transfusion between two groups.Also,there was no difference in postoperative mechanical ventilation time,ICU time and length of stay postoperatively.The postoperative complications were similar between two groups.Postoperative patency rate of the RIMA graft was as high as 95.2%.The target vessels of RIMA included left anterior descending branch(45 cases),diagonal branch(19 cases),intermediate branch(12 cases).obtuse marginal or circumflex branch(16 cases),posterior descending branch(5 cases)and right coronary trunk(18 cases).41 RIMA used as free grafts,87 used as in situ grafts,of which 19 RIMA need lengthened by other graft vessels.Conclusion The patency rate of RIMA graft is high and the application of RIMA do not increase the surgical risk significantly.However,there are versatile contour of RIMA grafts.It can be used as artery graft in selected patients.