左胸廓内动脉联合桡动脉行冠状动脉旁路移植术早期临床疗效

Early clinical efficacy of left internal thoracic artery plus radial artery in total arterialized coronary artery bypass grafting

目的探讨体外循环与非体外循环下左胸廓内动脉(left internal thoracic artery,LITA)联合桡动脉(radial artery,RA)行全动脉化冠状动脉旁路移植术(total arterialized coronary artery bypass grafting,TA-CABG)的早期临床效果。方法回顾性分析山东省千佛山医院心脏外科2020年1月至2022年6月接受全动脉化冠状动脉搭桥术105例患者临床资料,其中不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)患者59例,为OPCAB组,体外循环下冠状动脉旁路移植术(on-pump coronary artery bypass grafting,ONCAB)患者46例,为ONCAB组。分析包括术前资料、术中桥血管获取及吻合方式、术后并发症及处理措施,所有患者术后12个月复查冠状动脉CT血管造影(computed tomography angiography,CTA),并评估桥血管通畅率及不良心血管事件发生率。结果ONCAB组手术时间高于OPCAB组,术后住院时间小于OPCAB组,差异有统计学意义(P=0.006),两组术中吻合口个数、桥血管流量差异无统计学意义(P>0.05),术后机械通气时间、术后24 h引流量、心律失常、围术期心肌梗死、切口感染及前臂并发症差异无统计学意义(P>0.05),两组患者均无院内死亡及术后脑血管事件发生。结论体外循环与非体外循环下LITA联合RA行冠状动脉旁路移植术近期临床效果满意;ONCAB组术后住院时间少于OPCAB组;RA获取时应注意桡神经分支保护;术中及术后抗痉挛治疗十分重要。

Objective To investigate the early clinical efficacy of left internal thoracic artery(LITA)plus radial artery(RA)in total arterialized coronary artery bypass grafting(TA-CABG).Methods The clinical data of 105 patients who underwent total TA-CABG during Jan.2020 and Jun.2022 in the Department of Cardiovascular Surgery of Shandong Provincial Qianfoshan Hospital were retrospectively analyzed,including 59 who underwent off-pump coronary artery bypass grafting(OPCAB)and 46 who underwent on-pump coronary artery bypass grafting(ONCAB).Preoperative data,intraoperative graft acquisition and anastomosis methods,postoperative complications and management measures were included.Computed tomography angiography(CTA)was conducted in all patients 12 months after surgery to evaluate the graft patency rate and incidence of adverse cardiovascular events.Results The operation time of ONCAB group was longer than that of OPCAB group,while the postoperative hospital stay was shorter,with statistically significant difference(P=0.006).However,there were no statistically significant differences in the number of anastomosis,flow in grafts,postoperative mechanical ventilation time,24 h postoperative drainage,arrhythmia,perioperative myocardial infarction,incision infection and forearm complications(P>0.05).No death or postoperative cerebrovascular events occurred in either groups.Conclusion LITA plus RA yields satisfactory early clinical outcomes in TA-CABG.ONCAB group needs shorter hospital stay than OPCAB group.Protection of radial nerve branch is important when RA is obtained.Intraoperative and postoperative antispasmodic therapy is essential.