双侧乳内动脉在冠脉搭桥术中的应用

目的:探讨双侧乳内动脉在冠状动脉搭桥术中的应用价值。方法:行双侧乳内动脉冠状动脉搭桥手术患者37例,29例为3支病变,8例为左主干病变,13例术前有心梗,2例合并室壁瘤。36例在非体外循环下行冠状动脉搭桥手术,1例由OPCAB转为体外循环下冠脉搭桥。左侧乳内动脉(LIMA)到前降支及对角支,右侧乳内动脉(RIMA)到中间支、钝缘支及后降支。2例同时行室壁瘤切除,人均搭桥3.2支。结果:术后心梗导致低心排死亡1例。主动脉球囊反搏支持10例。术后出现切口感染1例,再次清创处理。随访12～39月(平均24.5个月),患者均无心绞痛再次发作。冠脉CTA检查显示双侧乳内动脉均通畅。结论:双侧乳内动脉在冠脉搭桥中,近期效果比较满意,远期效果尚待进一步随访。

Application of bilateral IMA in coronary artery bypass grafting

Objective:To evaluate the effects of application of bilateral internal mammary artery grafts in coronary artery bypass grafting(CABG).Methods:Underwent coronary artery bypass grafting with bilateral internal mammary artery grafts.The pathologic change involved three branches of coronary artery in 29 cases and involved the left main trunk in 8 cases.13 patients had the history of myocardial infarction,2 cases were complicated by left ventricular aneurysm.1 cases was operated upon on-pump and 36 off-pump.Left ventricular aneurysmectomy were done in 2 patients.The patterns of anastomosis were as follows: left internal mammary artery(LIMA) to left anterior descending artery(LAD) and the diagonal branch;right internal mammary artery(RIMA) to the ramus,obtuse marginal(OM) and PDA.The average number of grafts used for each case was 3.2.Results:There was 1 case early operative deaths,with an early operative mortality rate of 2.7%.The patient died of low out put syndrome due to perioperative myocardial infection.Intraaortic balloon pump were used in 10 cases post-operatively.Mediastinal infection occurred in 1 patients.The patients were followed up for 12 to 39 months(average 24.5 months).During the follow-up,no angina pectoris occurred and ultrasonography showed that the bilateral internal mammary artery grafts were unobstructed in all patients.Conclusion:Bilateral internal mammary artery grafts can beapplied effectively in CABG with a good short-term effect,especially for young patients.