Semi-skeletonized Internal Mammary Grafts and Phrenic Nerve Injury:Cause-and-effect analysis

Summary： Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries （2.5 %）. There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery （Odds ratio （OR）=14.5） and the presence of chronic obstructive pulmonary disease （OR=2.9）. Phrenic nerve injury was an independent risk factor （OR=8.1） for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself.

Fractional flow reserve measured via left internal mammary artery after coronary artery bypass grafting:Two case reports

BACKGROUND The fractional flow reserve(FFR)has made the treatment of coronary heart disease more precise.However,there are few reports on the measurement of FFR via the left internal mammary artery(LIMA).Herein,we described the determination of further treatments by measuring FFR via the LIMA in 2 cases after coronary artery bypass grafting(CABG).CASE SUMMARY Case 1 was a 66-year-old male who was admitted due to“chest tightness after CABG.”The patient underwent CABG 7 years prior due to coronary heart disease.Coronary artery angiography showed complete occlusion of the left anterior descending artery(LAD),and subtotal occlusion of the third segment of the right coronary artery.On arterial angiography,there was 85%stenosis at the distal end of the anastomosis of the LIMA-LAD graft.FFR via LIMA was determined at 0.75.Thus,balloon dilation was performed in Case 1.FFR after balloon dilation was 0.94.Case 2 was a 60-year-old male who was admitted due to“chest tightness after CABG.”The patient underwent CABG 6 years prior due to coronary heart disease.There was 60%segmental stenosis in the middle segment of LAD and 75%anastomotic stenosis.FFR measured via LIMA was 0.83(negative);thus the intervention was not performed.Case 2 was given drug treatments.At the 3-mo follow-up,there was no recurrence of chest tightness or shortness of breath in both cases.They are currently under continual follow-up.CONCLUSION We provided evidence that FFR measurement via grafted blood vessels,especially LIMA,after CABG is a good method to determine the intervention course.

Minimally Invasive Total Arterial Coronary Artery Bypass Grafting in Left Main Stem Disease

Objective: The aim was to show that Minimally Invasive total arterial revascularization for left main stem coronary artery disease, via a left anterior Mini thoracotomy using bilateral internal thoracic arteries is feasible, reproducible and safe. Further, there has been no exclusive data or experience with minimally invasive coronary artery bypass grafting in left main stem disease. Methods: From April 2019 to March 2024, 41 patients with left main stem stenosis, left main equivalent disease and unprotected left main with triple vessel disease underwent off pump minimally invasive multivessel coronary artery bypass grafting using either in situ pedicled Bilateral Internal Thoracic arteries or Left and Right Internal Thoracic artery Y composite conduits at three centers. Bilateral Internal Thoracic arteries were harvested under direct vision. All patients had an Intra-Aortic Balloon Pump inserted via the femoral artery prior to induction of anesthesia, to prevent any hemodynamic instability, arrhythmias, and was removed following completion of the procedure in the operating room without any complications. Efficacy and outcomes were evaluated by i) Primary (MACCE)-Major Adverse Cardiac and Cardiovascular events and ii) Secondary outcome measures including total length of stay, return to full physical activity and quality of life. Mean follow-up was 1.4 years (Maximum was 2.5 years). Results: 41 patients with left main stem coronary artery stenosis, underwent total arterial revascularization using bilateral internal thoracic arteries. Left main stem stenosis was present in 29 patients, Unprotected left main stem stenosis with triple vessel disease in 7 and left main equivalence in 5 patients. In this cohort, 29 patients with only left main stem stenosis had 2 grafts each, 7 patients with left main and triple vessel disease had 3 grafts and 5 patients with left main equivalent disease had 2 grafts respectively. The average number of grafts was 2.2. One patient was converted to open sternotomy as an emergency because of hemodynamic instability and myocardial revascularization was done on cardiopulmonary bypass (2.2%). The average hospital stay was 3.7 days. Ejection fraction was 45% ± 5%. There was one mortality (2.2%) but no major morbidity. The average ICU and hospital stay was 24 ± 4 hours and 3.7 days. All patients were free from major adverse cardiac and cerebrovascular events at follow-up. Conclusions: Multivessel total arterial revascularization using left and right internal thoracic arteries, was performed via a left anterior Mini thoracotomy on patients with left main stem disease and showed that it was safe, reproducible and will help extend the armamentarium of the surgeon in minimally invasive Coronary artery bypass grafting. Concomitantly it helped enhance the potential for shorter hospital stay, increased survival, decreased morbidity, and earlier return to full activity. Furthermore, the safety, efficacy, and outcomes of minimally invasive coronary artery bypass grafting in this high-risk group evaluated by primary and secondary outcome measures have been good in this study.

Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft

ObjectiveTo 评估离开泵的结果冠的动脉用一根双边的内部乳房的动脉(BIMA ) 绕过 grafting (OPCABG ) 完成全部的动脉的心肌的 revascularization.MethodsFrom 2002 年 10 月到 2008 年12月的 Y 配置接枝， 208 个病人( 196 男性和 12 女性)用 BIMA Y 配置接枝经历了 OPCABG 。病人的平均年龄是 56.5 &#x000b1；11.3 年，与 33-78 年的一个年龄范围。167 的一个总数(80.2%) 盒子有三倍容器的疾病。左主要的茎疾病在 33 被发现(15.9%) 盒子，和双容器疾病在 8 被发现(3.9%) 盒子。semi-skeletonization 技术被用来收获二根内部乳房的动脉(IMA ) ，然后免费恰好内部的乳房的动脉在 situ 是到左内部乳房的动脉(LIMA ) 的连接 end-to-side 完成 Y 配置接枝。离开泵和顺序的吻合方法被用来执行冠的动脉在所有病人绕过外科。接枝明显与 HT311 运输时间 flowmeter.ResultsA 总数 intra-operatively 被估计 728 远侧吻合在 208 个病人被执行，与是的一般水准 3.5 &#x000b1；1.3 每人。没有人死了或在用 BIMA Y 接枝的 operation.ConclusionsOPCABG 安全、有效完成全部的动脉的 revascularization 以后，在 30 天以内经历了周期性的咽峡炎。这个方法在上升主动脉和另外的切口上避免外科的操作。

Management of atherosclerotic plaque in left internal mammary artery graft five years after angiographic patency: A case report

BACKGROUND The left internal mammary artery(LIMA)has demonstrated excellent long-term patency rates when used as a bypass conduit with complications usually occurring in the early postoperative period.The rapid development of de-novo atherosclerosis in a previously non-diseased LIMA,subsequently leading to an acute coronary syndrome(ACS)is rarely encountered.CASE SUMMARY A 67-year-old man with history of triple coronary artery bypass graft(8 years ago)presented to our hospital with an ACS.He had undergone angiography 5 years ago to investigate episodic chest pain and imaging of the LIMA at the time did not demonstrate the atherosclerotic process.Emergent angiography demonstrated a severe diffuse stenosis in the proximal to mid segment of the LIMA,with embolization of a moderate sized thrombus to the distal skip segment.The LIMA stenosis was characterised by overlying haziness,consistent with acute plaque rupture,associated with residual luminal thrombus.The patient was managed with antithrombotic therapy to reduce the thrombus burden until repeat angiography after 72 h.At repeat angiography,the thrombus burden was substantially reduced at the distal skip segment as well as at the proximal to mid LIMA with the demonstration of multiple plaque cavities.This lesion was predilated and a 2.75 mm×33 mm everolimus-eluting stent was implanted to a final diameter of 3.0 mm.The patient made a good clinical recovery and was discharged after 6 d.CONCLUSION This case highlights the rapid and late development of atherosclerosis in a graft 5 years after documented patency and the importance for consideration of expectant thrombus management.

Management of Internal Mammary Artery Spasm

The article is dedicated to the management of internal mammary artery spasm intra- and postoperatively based on the accumulated evidence in the literature. It provides a stepwise decision algorithm for safely resolving the spasm and prevention of relapse.

Literature Review for the Management of Isolated Internal Mammary Artery Injury and a Case Managed by Mini-Thoracotomy

Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.

Prevention of Sternal Dehiscence Following Use of Bilateral Internal Mammary Arteries in OPCAB

Purpose: We harvested bilateral Internal Mammary Arteries and made LIMA-RIMA Y in all the patients undergoing OPCAB at our center irrespective of the presence or absence of various risk factors for sternal dehiscence. The purpose of this study was to find an effective way of sternal closure in patients undergoing OPCAB with both the Internal Mammary Arteries harvested for grafting. Method: The patients who did not have any risk factors were placed in group I and all of them had a standard six wire closure of sternotomy. The patients having any risk factors were placed in group II. The patients in group II were randomized by including every alternate patient from group II to subgroup II A and every other alternate patient from group II to subgroup II B. Patients in subgroup II A again had a standard closure of sternotomy while in patients of subgroup II B bilateral Robiscek repair and four-five interlocking figure of eight wires were used for closure of sternotomy. Results: The patients who had risk factors for sternal dehiscence had higher risk for sternal dehiscence as compared to patients without any risk factors if bilateral Internal Mammary Arteries were harvested for OPCAB. But if we used bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure then the rate of sternal complications in the patients with risk factors for sternal dehiscence was not more than the patients without risk factors. Conclusion: We can harvest bilateral Internal Mammary Arteries for OPCAB without fear of sternal complications even in patients with high risk for sternal dehiscence if we use bilateral Robiscek repair with four to five interlocking figure of eight wires for sternal closure.

Reconstruction of Chest Wall after Extensive Chest Wall Necrosis Caused by Transcatheter Arterial Embolization of Bilateral Internal Mammary Arteries Injured by Cardiopulmonary Resuscitation—A Case Report

Transcatheter Arterial Embolization (TAE) is known to be effective for controlling severe hemorrhage caused by iatrogenic or blunt trauma. Out of more than 100 cases of TAE performed in our hospital, we have treated some cases of skin or muscle necrosis that resulted from embolization of the main arteries. In this study, we report the case of a patient with significant chest wall necrosis after TAE of the bilateral internal mammary arteries (IMAs). A 66-year-old male was transported to our hospital for loss of consciousness while playing golf. Cardiopulmonary resuscitation (CPR) was performed for cardiac arrest, which resulted in several rib fractures and mediastinal hematoma due to bilateral mammary artery injuries. Immediate TAE embolization was performed because of continuous hemorrhage. He was referred to our department 16 days after embolization due to the presentation of chest wall necrosis. Heart, lungs and diaphragm were exposed after surgical debridement under systemic anesthesia. We performed several operations to reconstruct the anterior chest wall. His spontaneous respiration returned, and is now controlled with a tracheostomy tube. Complete epithelialization was achieved, and he was transferred to another hospital for further rehabilitation. To the best of our knowledge, this is the first report of chest wall necrosis resulting from TAE of IMAs. Arterial embolization can cause widespread necrosis of bone, muscle and skin. Although treatment required an extended period, we managed to reconstruct the chest wall with multidisciplinary strategies.

Bilateral vs unilateral internal mammary revascularization in patients with left ventricular dysfunction

AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery(LIMA)-saphenous venous grafting(SVG).RESULTS The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups(7.8% vs 10.3%,P = 0.49). Early postoperative morbidity included myocardial infarction(4.2% vs 3.8%,P = 0.80),stroke(1.2% vs 3.8%,P = 0.14),and mediastinitis(5.3% vs 2.3%,P = 0.11). At 8-year follow-up,Kaplan-Meier-estimated survival(74.2% vs 58.9%,P = 0.02) and Kaplan-Meier-estimated event-free survival(all cause deaths,myocardial infarction,stroke,target vessel revascularization,heart failure)(61.7% and 41.1%,P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival(P = 0.40) and event-free survival(P = 0.13) in comparison with LIMA-SVG use.CONCLUSION Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.

不同乳内动脉游离方法在冠状动脉旁路移植中的应用效果比较

目的探究不同乳内动脉游离方法下冠状动脉旁路移植的安全性及术后远期预后。方法回顾性选取2016年1月至2020年3月在河南科技大学第一附属医院接受冠状动脉旁路移植术的患者117例,根据患者乳内动脉游离方式分组,A组患者接受带蒂法游离胸廓内动脉,B组患者接受骨骼化法游离胸廓内动脉。对两组患者术中临床指标、围手术期指标及术后并发症发生情况进行记录。对患者进行3 a随访,记录两组患者随访期内心绞痛分级情况及不良心血管事件发生情况。结果两组患者的手术时间、远端吻合口数、左侧乳内动脉流量、左侧乳内动脉搏动指数、右侧乳内动脉流量、右侧乳内动脉搏动指数差异无统计学意义(P>0.05)。两组患者的呼吸机辅助时间、左心室射血分数、左心室舒张末期内径、术后切口疼痛情况比较,差异无统计学意义(P>0.05)。B组患者的术后胸腔积液量少于A组,ICU停留时间短于A组(P<0.05)。B组患者术后总并发症发生率低于A组(P<0.05)。随访期止时,B组患者高等级心绞痛发生率低于A组(P<0.05)。两组患者不良心血管事件发生率差异无统计学意义(P>0.05)。结论在冠状动脉旁路移植手术中,骨骼化法游离胸廓内动脉在术后并发症发生率、胸腔积液量、ICU停留时间以及高等级心绞痛的发生率等方面表现优于带蒂法游离胸廓内动脉。

Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system

Background Off-pump coronary artery bypass surgery （OPCAB） has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB.Methods From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out.Results Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 （P〈0.05）. In both groups, the mean New York Heart Association （NYHA） class and ejection fraction increased significantly （P〈0.001） and the mean left ventricular end-diastolic diameter decreased significantly （P 〈0.05）. Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein.Conclusions Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.

比较获取不同乳内动脉行不停搏冠状动脉旁路移植术的早期效果

目的:比较骨骼化乳内动脉(IMA)与带蒂IMA行不停搏冠状动脉旁路移植术(OPCABG)后的早期临床效果。方法:选取2020年10月至2022年4月首都医科大学大兴教学医院110例单纯行胸骨正中切口的OPCABG患者,搭桥方式均为左侧IMA与前降支吻合。其中男性81例,女性29例,平均年龄(58.6±8.7)岁。根据术中IMA获取情况,分为骨骼化IMA组(54例)和带蒂IMA组(56例)。比较2组IMA获取时间、住院时间、吻合后血管流速、术后引流量、术后第2天C反应蛋白、胸部切口感染、胸骨哆开等情况。结果:与带蒂IMA组比较,骨骼化IMA组吻合后桥血管流速更快[(73.56±40.16)mL/min对(58.26±33.27)mL/min],获取时间更长[(31.6±7.8)min对(24.3±8.1)min],术后总引流量更少[(428.6±318.7)mL对(541.7±332.5)mL],2组比较差异有统计学意义(P<0.05)。2组术后第2天C反应蛋白、胸部切口感染、胸骨哆开及住院时间等差异无统计学意义。OPCABG后平均随访15个月,2组主要不良心脑血管事件发生率、乳内动脉桥通畅率、大隐静脉桥通畅率的差异无统计学意义。结论:获取骨骼化IMA比带蒂IMA时间长,难度高,但术后桥血管血流更好,动脉桥更长,可序贯弥漫病变前降支,且术后总引流量更少,骨骼化IMA在OPCABG中应用早期疗效满意。

带蒂内乳动脉穿支皮瓣在内下象限乳腺癌保乳术中的应用

目的 探讨采用带蒂内乳动脉穿支(internal mammary artery perforator, IMAP)皮瓣修复内下象限乳腺癌保乳术后乳房局部缺损的可行性及美容效果。方法 回顾性分析2018年2月—2021年2月郴州市第一人民医院甲乳外科收治的12例乳腺癌患者临床资料。所有患者肿瘤均位于内下象限,所有患者均采用带蒂IMAP皮瓣修复保乳术后乳房局部缺损,记录每次穿支血管解剖情况,观察手术相关指标(皮瓣制作时间、切除病灶组织量、手术时间及切缘二次扩切率)及术后并发症,评价术后美容效果。结果 12例患者的整形保乳术均成功完成,术中发现内乳动脉穿支血管相对恒定,皮瓣制作耗时为(12±2)min。术中切除病灶组织量为(98.0±16.5)g,手术时间为(105±15)min,切缘二次扩切率为16.7%。术后有1例出现皮瓣尖端坏死及1例皮下脂肪液化,经换药后均痊愈,余10例均一期愈合,术后并发症发生率为16.7%。术后美容效果评价优良率为91.7%,术后平均随访36个月,未见局部复发,仅1例出现骨转移。结论 采用带蒂IMAP皮瓣修复内下象限乳腺癌保乳术后局部缺损,手术可操作性强,创伤小,美容效果好,值得临床推广。

Flexible Subclavian Artery Closure for an Inadvertent Injury to the Internal Mammary Artery During Internal Jugular Vein Catheterization

Central vein catheter （CVC） placement, which is widely utilized in clinical departments, is also highly important in preoperative preparations for radiofrequency catheter ablation （RFCA）. The internal jugular vein or subclavian vein is the routine target. Arterial injury is not uncommon during the procedure but is potentially devastating in spite of the safety and advantages of the Seldinger technique. Compressing of the airway by a hematoma, as well as hemothorax, pseudoaneurysm, arteriovenous fistula, stroke, and even death, has been well-described.

What can we learn from cases of internal mammary artery damage in coronary artery bypass graft?

From July 1997 to April 2017, 286 cases of internal mammary artery (IMA) damage were recorded out of the 10,360 coronary artery bypass graft (CABG) operations with IMA harvest, with an incidence up to 2.7%, which is relatively high. The main reason for such high incidence might be the surgeons’ experience and the learning curve. Although one surgeon (Huang FJ) performed all these operations, the cases were operated in many different hospitals, and more than 200 surgical assistants who were young and inexperienced harvested the IMA.

Internal mammary artery harvesting with its distal end occluded

To the Editor:We have read with great interest the comment of Chen et al"What can we learn from cases of internal mammary artery damage in coronary artery bypass graft ", The advice that the authors propose in relation to the internal mammary artery (IMA) harvesting is very useful because they are based on a 20-year experience in more than 10,000 patients.

术前乳内动脉超声检查在冠状动脉旁路移植术中的应用价值

目的:探讨术前乳内动脉超声检查在冠状动脉旁路移植术中的应用价值。方法:回顾性分析2018年1月1日至12月31日在北京大学人民医院行冠状动脉旁路移植术(CABG)的281例患者临床资料,统计术前乳内动脉超声检查结果,比较左、右乳内动脉的各项超声检查指标(乳内动脉直径、血流量、搏动指数),并结合患者乳内动脉的使用及手术中乳内动脉桥的超声测量结果,进行统计学和临床分析。结果:本研究共纳入281例行CABG的患者,男性210例(74.7%),术前乳内动脉超声显示左、右乳内动脉直径分别为(1.95±0.15)mm和(1.97±0.17)mm(P=0.014),血流量分别为(15.4±5.9)ml/min和(18.2±7.2)ml/min(P<0.001),搏动指数分别为4.12±1.40和3.90±1.19(P<0.001)。术前乳内动脉超声发现乳内动脉血流异常3例。Pearson相关性分析显示原位左乳内动脉血流量与直径相关(r=0.319,95%CI:0.205~0.425,P<0.001),原位左乳内动脉直径、血流量与乳内动脉桥血管血流量不相关(r分别为0.049和0.005,P均>0.05),临床左乳内动脉使用264例,原位使用261例(98.9%);右乳内动脉使用29例,原位使用21例(72.4%)。结论:本研究显示右乳内动脉直径和血流量优于左乳内动脉;术前乳内动脉超声检查可筛选出不宜原位用作桥血管材料的乳内动脉,右乳内动脉的使用方式变化较大。

不停跳冠状动脉旁路移植术骨骼化与带蒂乳内动脉术后早期疗效研究

目的:研究两种不同乳内动脉(internal mammary artery,IMA)获取方式下患者术中以及术后早期治疗效果的差异。方法:回顾性分析从2021年1月至9月,单纯行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)的患者97例,其中男性75例,女性22例,平均年龄(59.4±8.4)岁。根据患者术中IMA获取方式分为骨骼化左乳内动脉组(47例)及带蒂LIMA组(50例)。均采用胸部正中切口OPCABG术式,两组IMA取材均为左侧IMA,行LIMA与前降支(LAD)或LIMA与对角支(D)吻合。通过收集对比患者术中、术后住院时基本情况以及出院后1年情况评估两种方式获取乳内动脉的安全性和有效性。结果:骨骼化组术中LIMA桥血管流量高于带蒂组[71(46,97)vs.53.5(41.75,80.75)mL/min,P=0.044],骨骼化IMA组获取LIMA时间长于带蒂IMA组[(30.4±7.6)vs.(23.1±8.2)min,P<0.001],但骨骼化IMA组整体手术时间与带蒂IMA组,差异无统计学意义[(4.8±0.6)vs.(4.8±0.7)h,P>0.05]。骨骼化IMA组患者术后引流量少于带蒂IMA组[420(330,700)vs.560(397.5,797.5)m L,P=0.028]。1年后两组随访患者无心绞痛复发,随访率86.6%(40/44)。结论:骨骼化获取乳内动脉可减少术后患者失血,患者术后早期预后较好,疗效满意,骨骼化乳内动脉的中远期疗效还需要进一步的研究验证。

冠状动脉储备功能与左心功能变化在左乳内动脉原位转流术中的应用价值

目的探讨左心功能相关指标与冠状动脉储备功能在左乳内动脉原位转流术中的应用价值。方法选取采用左乳内动脉作为桥血管进行冠状动脉旁路移植术患者50例,术前1周及术后1个月超声检查评估患者左乳内动脉及心脏相关指标,观察左心室壁运动情况并进行评分,同时利用斑点追踪技术采集左心室壁各阶段径向应变(RS)及径向应变率(RSr)。小剂量多巴酚丁胺负荷超声心动图(LDDSE)检查后重复上述操作。结果患者术前、术后超声检查均能清晰显示左乳内动脉管腔及血流情况,左乳内动脉频谱由术前收缩期优势型转变为术后舒张期优势型频谱,为低阻力血流,术后乳内动脉起始段的显示率为100%,内径较术前增宽,PSV及PDV较前增加,阻力指数减低,且术后舒张期流速时间积分及舒张期流速时间积分分数明显增加。乳内动脉-左侧锁骨下动脉夹角与术中桥血管流量呈负相关,术后1个月桥血管流量较术中流量明显增加。左乳内动脉原位转流术患者存活心肌静息及负荷状态RS、RSr低于非存活心肌,存活心肌、非存活心肌静息状态RS、RSr高于负荷状态。结论超声心动图可评估短期桥血管的通畅程度,分析影响桥血管流量的因素,斑点追踪技术联合小剂量多巴酚丁胺负荷检查可有效区分心肌梗死中存活心肌与非存活心肌。