Complete Myocardial Revascularization Using Only Pedicle Arterial Grafts

完全使用帶莖動脈導管施行冠狀動脈繞道手術

李君儀(Jiun-Yi Li) ； 胡珀元(Po-Yuan Hu) ； 吳協兆(Shye-Jao Wu) ； 孫坤(Shen Sun) ； Chen-Yen Chien

《Acta Cardiologica Sinica》 20卷2期 (2004/06) Pp. 87-93

摘要

背景 雖然隱靜脈導管已經廣泛使用於冠狀動脈繞道手術，歷年文獻報告指出它比動脈導管更容易發生血管硬化，使得部份心臟外科醫師轉而利用雙側內乳動脈及右胃網膜動脈以施行完全使用帶莖的動脈導管施行冠狀動脈繞道手術。由於國內尚無大規模使用此方法施行冠狀動脈繞道手術之研究報告，本研究探討此手術方式的短期結果。
方法 本院1999 年2 月至2003 年1 月間共171 位病患術前計畫接受完全使用帶莖動脈導管施行之冠狀動脈繞道手術，其中22 位需要額外的靜脈導管，149 位完成此手術，即完全使用帶莖的雙側內乳動脈及右胃網膜動脈進行冠狀動脈繞道手術。本研究分析這149 位病患手術前後的臨床資料。
結果 共摘取399 條動脈導管，完成434 處冠狀動脈吻合，平均每位病患接受2.9 處冠狀動脈吻合 (範圍, 1 ~ 5 處)，所有149 位病患都有使用左內乳動脈、131 位病患 (87.9%) 有使用右內乳動脈，119 位病患 (79.9%) 有使用右胃網膜動脈，有35 條動脈導管用於2 處冠狀動脈吻合。6 位病患 (4.1%) 術後需要重開胸止血、2 位病患 (1.4%) 發生術後心肌梗塞、7 位病患 (4.8%) 發生胸部傷口感染、3 位病患 (2.1%) 於術後30 天內死亡。
結論 由本院之經驗顯示完全使用帶莖動脈導管施行冠狀動脈繞道手術是相當安全而且預期能帶給病患長期的好處。

並列摘要

Background: Although widely applied in the coronary artery bypass surgery, saphenous vein graft is more vulnerable to atherosclerosis than arterial grafts. The use of bilateral internal mammary arteries (IMA) as well as right gastroepiploic artery (RGEA) provides the possibility of complete arterial revascularization in multi-vessel coronary artery disease.We reported the short-term outcome of complete myocardial revascularization with only pedicle arterial grafts.
Methods: Between February 1999 and January 2003, 171 patients were planned to receive complete myocardial revascularization with only pedicle arterial grafts. Additional vein grafts were required in 22 patients and the other 149 patients were operated on using the technique. All procedures were performed by using internal mammary and right gastroepiploic arteries. We reviewed perioperative and postoperative data of these patients.
Results: A total of 399 arterial grafts were harvested and 434 distal anastomoses were created, an average of 2.9 (range, 1-5) per patient. LIMAwas used in all 149 patients, RIMAwas used in 131 patients (87.9%), and RGEAwas used in 119 patients (79.9%). Thirty-five arterial grafts were used for sequential grafting. Six patients (4.1%) had reoperations for mediastinal bleeding. Two patients (1.4%) experienced perioperative myocardial infarction.
Sternal wound infection occurred in 7 patients (4.8%). Three patients (2.1%) died in the hospital within 30 days ofoperation.
Conclusion: Our experience shows that complete arterial revascularization can be safely performed. The long-term benefit for patients could be expected.

並列關鍵字

Myocardial revascularization ； Internal mammary artery ； Right gastroepiploic artery