双边内部乳腺动脉移植是否会降低冠状动脉复发的长期风险? 一个多中心分析

Alexander Iribarne ¹, Joseph D Schmoker ², David J Malenka ²

¹From Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (A.I., D.J.M., J.N.M., J.P.D., E.M.O., A.W.D.); Department of Medicine, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (D.J.M.); Department of Surgery, Section of Cardiac Surgery, University of Vermont Medical Center, Burlington (J.D.S., B.J.L.); Department of Surgery, Section of Cardiac Surgery, Central Maine Medical Center, Lewiston (P.W.W.); Department of Surgery, Section of Cardiac Surgery, Catholic Medical Center, Manchester, NH (B.M.W.); Department of Surgery, Section of Cardiac Surgery, Maine Medical Center, Portland (R.D.Q., R.S.K.); Department of Surgery, Section of Cardiac Surgery, Eastern Maine Medical Center, Bangor (J.D.K.); and Department of Surgery, Section of Cardiac Surgery, Concord Hospital, NH (G.L.S.). alexander.iribarne@hitchcock.org.
²From Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (A.I., D.J.M., J.N.M., J.P.D., E.M.O., A.W.D.); Department of Medicine, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (D.J.M.); Department of Surgery, Section of Cardiac Surgery, University of Vermont Medical Center, Burlington (J.D.S., B.J.L.); Department of Surgery, Section of Cardiac Surgery, Central Maine Medical Center, Lewiston (P.W.W.); Department of Surgery, Section of Cardiac Surgery, Catholic Medical Center, Manchester, NH (B.M.W.); Department of Surgery, Section of Cardiac Surgery, Maine Medical Center, Portland (R.D.Q., R.S.K.); Department of Surgery, Section of Cardiac Surgery, Eastern Maine Medical Center, Bangor (J.D.K.); and Department of Surgery, Section of Cardiac Surgery, Concord Hospital, NH (G.L.S.).

⁰From Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (A.I., D.J.M., J.N.M., J.P.D., E.M.O., A.W.D.); Department of Medicine, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (D.J.M.); Department of Surgery, Section of Cardiac Surgery, University of Vermont Medical Center, Burlington (J.D.S., B.J.L.); Department of Surgery, Section of Cardiac Surgery, Central Maine Medical Center, Lewiston (P.W.W.); Department of Surgery, Section of Cardiac Surgery, Catholic Medical Center, Manchester, NH (B.M.W.); Department of Surgery, Section of Cardiac Surgery, Maine Medical Center, Portland (R.D.Q., R.S.K.); Department of Surgery, Section of Cardiac Surgery, Eastern Maine Medical Center, Bangor (J.D.K.); and Department of Surgery, Section of Cardiac Surgery, Concord Hospital, NH (G.L.S.). alexander.iribarne@hitchcock.org.

与单个内部乳腺动脉 (SIMA) 移植相比,双边内部乳腺动脉 (BIMA) 移植减少了重复冠状动脉再血管化的需要. 这种改善的长期存活率和降低的复血管化风险表明,在冠状动脉旁路移植中,应更频繁地考虑使用BIMA.

科学领域

心血管外科
胸部手术
血管外科

背景情况

冠状动脉旁路移植 (CABG) 是治疗冠状动脉疾病的关键手术.
与单个内部乳腺动脉 (SIMA) 导管相比,双边内部乳腺动脉 (BIMA) 导管的长期存活率更高.
在BIMA与SIMA移植后重复血管化的数据较少.

研究的目的

通过BIMA对患者进行CABG的频率,时间和重复冠心血管化的类型进行比较.
评估与BIMA和SIMA移植相关的长期结果,以重血管化和存活为准.

主要方法

在1992年至2014年间对47,984次心血管外科手术进行了多中心的回顾性分析.
进行倾向匹配分析,将接受BIMA的1297名患者与接受SIMA的1297名患者进行比较.
主要终点:没有重复冠状动脉再血管.

主要成果

BIMA移植与明显更高的重复血管化无关 (HR,0. 78;P=0. 009).
在BIMA患者中,重复血管化发生在15. 1%,而在SIMA患者中,这一比例为19. 4% (P=0. 004).
在12年内,BIMA移植也减少了全因死亡率 (HR,0. 79;P=0. 001),但没有增加住院发病率.

结论

双边内部乳腺动脉移植与重复血管化的风险降低有关.
在冠状动脉旁路移植后,BIMA移植改善了长期生存.
在CABG过程中应增加对BIMA导管的考虑.

关键词:

冠状动脉绕道乳腺动脉心肌复血管化治疗结果血管移植

双边内部乳腺动脉移植是否会降低冠状动脉复发的长期风险? 一个多中心分析

概括

科学领域

背景情况

研究的目的

主要方法

主要成果

结论

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双边内部乳腺动脉移植是否会降低冠状动脉复发的长期风险? 一个多中心分析

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概括

科学领域

背景情况

研究的目的

主要方法

主要成果

结论

关键词:

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