在患有功能障碍的患者中,单一或双边内胸动脉移植
Ariel Farkash1, Amit Gordon1, Rephael Mohr1
1Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
PloS one
|February 14, 2024
概括
在功能受损的患者中,双边内胸动脉 (BITA) 移植并没有影响早期结果,但与单一 ITA (SITA) 移植相比,显著改善了长期存活率.
科学领域:
- 心血管外科心血管外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 外科手术的结果
背景情况:
- 对于患有功能障碍的患者来说,最优的手术复血管化策略尚不清楚.
- 冠状动脉旁路移植 (CABG) 是多血管疾病的常见治疗方法.
- 功能障碍是心脏手术后不良结果的重要危险因素.
研究的目的:
- 为了比较双边内胸动脉 (BITA) 与单个内胸动脉 (SITA) 移植的早期和晚期结果,在接受隔离CABG的功能受损患者中.
- 评估BITA与SITA对死亡率,中风,心肌梗塞和胸腔感染的影响.
- 评估BITA移植在这个患者群体中的长期生存益处.
主要方法:
- 在1996年至2011年间,对患有多血管疾病的患者和估计的膜过率<60mL/min/1.73m2的患者进行了回顾性分析,这些患者接受了孤立的CABG.
- 接受BITA (n=212) 和SITA (n=179) 移植的患者之间的结果比较.
- 多变量分析和匹配的队列分析 (134对),以调整潜在的混因素.
主要成果:
- 在BITA和SITA组之间,30天死亡率或早期并发症 (中风,心肌梗塞,胸部感染) 没有统计学上显著的差异.
- BITA组的长期存活率显著改善 (中位数为8.36年与4.14年,p<0.001).
- 多变量分析显示,BITA重血管化与未匹配 (HR=0.704) 和匹配 (HR=0.35) 队列中的晚期死亡率降低有关.
结论:
- 双边内胸动脉 (BITA) 重血管化不会对慢性功能衰竭 (CRF) 患者的早期结果产生不利影响.
- BITA移植在患有功能障碍的患者中对长期生存有显著的保护作用.
- 应考虑BITA移植作为选择多血管疾病和功能障碍患者的优越再血管化策略.
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