在糖尿病患者中进行双边或单边的内部乳腺再血管化
Masahiro Endo1, Yasuko Tomizawa, Hiroshi Nishida
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Endo@hij.twmu.ac.jp
Circulation
|August 27, 2003
概括
双边内部乳腺动脉 (BIMA) 移植改善了糖尿病患者的移植通透性和长期存活率,这些患者接受了冠状动脉旁路移植 (CABG) 以保存的喷射分数. 然而,减少的射出分数限制了BIMA移植的生存益处.
科学领域:
- 心血管外科心血管外科
- 糖尿病学 糖尿病学
- 胸部外科手术 胸部外科手术
背景情况:
- 冠状动脉旁路移植 (CABG) 是多血管疾病的常见程序.
- 使用内部乳腺动脉 (IMA) 移植是标准的做法.
- 双边IMA (BIMA) 移植在糖尿病患者中的益处仍然是调查的主题.
研究的目的:
- 在接受CABG的糖尿病患者中,与单个IMA (SIMA) 移植相比,评估BIMA移植的疗效.
- 评估早期和长期结果,包括移植通透性和存活率.
- 为了确定弹射分数是否影响BIMA移植的益处.
主要方法:
- 历史上的1131名患者的队列研究,这些患者接受了孤立的,初级的,多重的CABG与骨架化的IMA移植.
- 接受SIMA (n=277) 和BIMA (n=190) 移植的糖尿病患者之间的比较.
- 随访时间中位数为8.1年,分析了移植通透性,医院死亡率和长期存活率.
主要成果:
- 在BIMA (97.7%) 与SIMA (93.8%) 相比,早期的移植通透率显著更高.
- 在SIMA和BIMA组之间,整体生存率没有显著差异.
- 在被保存的喷射分数的患者中,BIMA使用与显著更高的10年生存率和改善免受不良心脏事件的相关性.
结论:
- 骨化BIMA移植在冠状动脉复血管化方面为糖尿病患者提供了显著的好处,这些糖尿病患者的喷射分数被保存.
- 在糖尿病患者中,由于心脏死亡率较高,BIMA移植的生存益处是有限的.
- 应考虑在选择的糖尿病患者中进行BIMA移植,以改善长期结果.
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