[Early clinical outcomes of minimally invasive coronary surgery-total arterial coronary revascularization].

• DOI: 10.3760/cma.j.issn.0376-2491.2019.14.006
• Publication Date: 2019-04-09
• Authors: Yichen Gong; Yunpeng Ling; Shuangquan Wu; Zhenshuang Cui; Hui Zhao; L F Zhang; Zhu Song; Yuanhao Fu; Heyin Yang
• Keywords: Male; Treatment Outcome; Endovascular Procedures; Coronary Artery Bypass, Off-Pump; Humans; Female; Mammary Arteries; Middle Aged; Coronary Vessels; Aged; Retrospective Studies

Objective: To summarize the early experience and clinical value of minimally invasive coronary surgery-total arterial revascularization (MICS-TACR) through left anterior small incision. Methods: Between May 2015 June 2018, a total 31 consecutive cases [21 males 10 females, aged (63.2±9.3) years] in Peking University Third Hospital who were performed MICS-TACR with bilateral internal mammary artery radial enrolled. Meanwhile, 1 489 conventional median sternal incision off-pump bypass grafting (OPCABG) matched as control group. According to exclusion criteria matching score, 90 [55 35 (63.8±9.5) selected group, perioperative data two groups compared. All patients group underwent postoperative angiography graft patency was evaluated. Results: There no statistically significant differences baseline between groups. The blood transfusion less than [0(0,0) U vs 0(0,4) U, P=0.003]. operative mortality, intraoperative intra-aortic balloon pump (IABP) extracorporeal membrane oxygenation (ECMO) use, re-operation rate, major adverse cardiac cerebrovascular events (MACCE), new-onset renal failure, atrial fibrillation, multiple organ failure Postoperative showed that there difference rate group(all P>0.05). Conclusion: Total can be successfully accomplished under incision, outcome is satisfied.目的： 总结评估左前外侧小切口直视下应用全动脉化冠状动脉旁路移植（MICS-TACR）早期经验及临床价值。 方法： 选取2015年5月至2018年6月在北京大学第三医院心脏外科完成左前外侧小切口获取双侧乳内动脉及桡动脉行MICS-TACR术连续性病例31例，男21例，女10例，年龄（63.2±9.3）岁。同期我院完成常规正中切口非体外循环冠状动脉旁路移植（OPCABG）1 489例，经过排除标准筛选及匹配性评分，选取90例作为对照组，男55例，女35例，年龄（63.8±9.5）岁。比较两组围手术期资料。对全部小切口手术患者术后早期复查造影，评价桥血管通畅率情况。 结果： 匹配后两组患者性别、年龄、合并症、心功能分级等基线资料差异均无统计学意义（均P>0.05）。MICS-TACR组围手术期红细胞使用少于OPCABG组[0（0，0）U比0（0，4）U，Z=-2.976，P=0.003]，两组患者在手术死亡率、术中及术后主动脉内球囊反搏（IABP）及体外膜肺氧合（ECMO）、再次手术率、围手术期主要心脑血管事件（MACCE）、新发肾功能衰竭、新发房颤、多器官功能衰竭比例差异均无统计学意义（均P>0.05）。复查造影结果显示，全部动脉桥血管非闭塞率（Fitzgibbon A+B级）达到98.5%，其中左乳内动脉及右乳内动脉桥通畅率为100%。 结论： 经左前外侧小切口直视下可成功完成MICS-TACR术，近期临床效果良好。.