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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (5): 18-25.doi: 10.6040/j.issn.1671-7554.0.2024.0850

• 重点专题——动脉桥在冠脉旁路移植中的应用 • 上一篇    

解剖完全再血管化全动脉冠脉旁路移植术多中心应用中期结果

国科1,陈绪军2,郑宝石3,黄克力4,王晓武5,陈景伟6,林宇7,罗俊辉8,王海晨9,王振东10,廖成全11,李有金12,陈文生13   

  1. 1.遵义医科大学附属医院心脏大血管外科, 贵州 遵义 563003;2.华中科技大学同济医学院武汉市第一医院心外科, 湖北 武汉 430022;3.广西医科大学第一附属医院心脏外科, 广西 南宁 530021;4.四川省人民医院心脏外科中心, 四川 成都 610072;5.南方医科大学珠江医院心外科, 广东 广州 510280;6.茂名市人民医院心外科, 广东 茂名 525000;7.广东省中医院心外科, 广东 广州 510006;8.中国人民解放军联勤部队989医院心胸外科, 河南 洛阳 471031;9.西安交通大学第一附属医院心外科, 陕西 西安 710061;10.临汾市人民医院心脏外科, 山西 临汾 041000;11.粤北人民医院心外科, 广东 韶关 512026;12.宁夏回族自治区人民医院心外科, 宁夏 银川 750002;13.西安高新医院心外科, 陕西 西安 710075
  • 发布日期:2025-05-07
  • 通讯作者: 陈绪军. E-mail:chenstan@163.com

Multi-center mid-term clinical outcomes in coronary patients undergoing total arterial bypass surgery with anatomic complete revascularization in China

GUO Ke1, CHEN Xujun2, ZHENG Baoshi3, HUANG Keli4, WANG Xiaowu5, CHEN Jingwei6, LIN Yu7, LUO Junhui8, WANG Haichen9, WANG Zhendong10, LIAO Chengquan11, LI Youjin12, CHEN Wensheng13   

  1. 1. Department of Cardiovascular Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, China;
    2. Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China;
    3. Department of Cardiovascular Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China;
    4. Cardiac Surgery Center, Sichuan Provincial Peoples Hospital, Chengdu 610072, Sichuan, China;
    5. Department of Cardiovascular Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China;
    6. Department of Cardiovascular Surgery, Peoples Hospital of Maoming City, Maoming 525000, Guangdong, China;
    7. Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510006, Guangdong, China;
    8. Department of Cardiothoracic Surgery, 989 Hospital of the Joint Service Force of the Chinese Peoples Liberation Army, Luoyang 471031, Henan, China;
    9. Department of Cardiovascular Surgery, First Affiliated Hospital of Xian Jiaotong University, Xian 710061, Shaanxi, China;
    10. Department of Cardiovascular Surgery, Linfen Peoples Hospital, Linfen 041000, Shanxi, China;
    11. Department of Cardiovascular Surgery, Yuebei Peoples Hospital, Shaoguan 512026, Guangdong, China;
    12. Department of Cardiovascular Surgery, Ningxia Hui Autonomous Region Peoples Hospital, Yinchuan 750002, Ningxia, China;
    13. Department of Cardiovascular Surgery, Xian High-tech Hospital, Xian 710075, Shaanxi, China
  • Published:2025-05-07

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摘要： 目的 探讨解剖完全再血管化(anatomic complete revascularization, ACR)全动脉冠脉旁路移植术(total arterialization myocardial revascularization, TAR)治疗冠心病的中期效果。 方法 纳入2018年1月到2024年4月间,在13所医院的心脏病中心行TAR的患者117例,其中男80例、女37例,33~67(55.5±9.7)岁,合并原发性高血压50例,糖尿病57例。重度左主干病变47例,三支病变103例,冠脉病变中,慢性冠脉闭塞病变33例。 结果 117例手术中共获取带蒂左内乳动脉(left internal mammary artery, LIMA)桥 117支、左(radial artery, RA)桥117支、右RA桥114支及游离右内乳桥47支。复合 Y动脉桥57支,其余均为单支桥。远端吻合口(4.2±0.4)个。升主动脉阻断时间与体外循环时间分别为(101.5±15.4)min与(145.4±19.2)min。气管插管时间(8.5±9.3)h。 21例术中安装主动脉球囊反搏。术后发生房颤10例,前臂血肿6例;心肌梗死1例,急性肾功能不全5例。无手术死亡,无胸骨感染/不愈合发生。随访(64.3±7.5)个月,随访率100%,随访期间患者死亡3例,其中,新型冠状病毒感染2例、结肠癌1例;左室射血分数［(60.3%±9.3%)vs.(55.0%±7.3%),t=20.01,P<0.001)］与心功能(纽约心功能分级≤2级94.74% vs. 80.34%, χ2=10.90, P<0.001)均有显著性改善。共有91例进行了CTA 随访,随访时间为(40.5±7.7)个月,左LIMA桥、左RA桥、右RA桥及右内乳桥通畅率分别为97.80%、86.81%、93.41%与94.50%(χ2=9.062,P=0.028)。 结论 本研究通过多中心研究 初步证实ACR 的TAR治疗冠心病近期安全、中期结果满意。

关键词: 冠心病, 冠状动脉旁路移植术, 全动脉化, 解剖完全再血管化, 多中心, 中期结果

Abstract: Objective To evaluate the safety and efficacy of total arterial myocardial revascularization(TAR)with anatomical complete revascularization(ACR)in treatment of coronary heart patients. Methods Between January 2018 and April 2024, a total of 117 patients, including 80 males and 37 females, 33-67 years old, with an age of(55.5±9.7)years, received TAR in 13 cardic surgery centers. There were 50 patients with primary hypertension and 57 patients with diabetes mellitus. Among them, there were 47 of severe left main lescons and 103 of triple vessel lesions, including 33 cases of chronic total occlusions. Results A total of 117 pedicled left internal mammary artery(LIMA), 117 left radial artery(LRA), 114 right radial artery(RRA), and 47 free right mammary artery grafts(RIMA)were observed in 117 patients. A total of 57 composite Y arterial grafts were constructed while the rest were single arterial graft. The number of distal anastomosis was(4.2±0.4). The time for ascending aorta clamp and bypass duration was(101.5±15.4 )minutes and(145.4±19.2)minutes, respectively. The duration of tracheal intubation was(8.5±9.3)hours. Intraoperative aortic balloon bump was implanted in 21 cases. Postoperatively, 10 patients developed atrial fibrillation, 6 had forearm hematomas, 1 experienced myocardial infarction, and 5 developed acute renal insufficiency. No surgical deaths occurred. No patients had chest bone infections/non healing. The follow-up duration was(64.3±7.5)months, with a 100% follow-up rate. During the follow-up period, 3 patients died, among them, 2 of COVID-19 and 1 of colon cancer. It was showed that left ventricular ejection fraction ［(60.3%±9.3%)vs.(55.0%±7.3%), t=20.01, P<0.001］ and cardiac function(94.74% vs. 80.34%, New York Heart Association class ≤ 2, χ2=10.90, P<0.001)were improved significantly. A total of 91 patients underwent CT angiography(CTA), with duration of(40.5±7.7)months and it was showed that patency rates of LIMA, LRA, RRA, and RIMA was 97.80%, 86.81%, 93.41%, and 94.50% respectively in CTA(χ2=9.062, P=0.028). Conclusion This multicenter study preliminarily confirmed that TAR with ACR is safe in the short-term and has satisfactory results in the med-term in the treatment of coronary artery disease.

Key words: Coronary heart disease, Coronary artery bypass grafting, Total arterial, Anatomic complete revascularization, Multi-center, Mid-term outcome

中图分类号: 

  • R654
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