CAJ | 학술논문

目的总结机器人冠状动脉旁路移植与支架植入的杂交手术近期临床结果.方法 2007年1月~2013年5月,35例患者接受器人冠状动脉旁路移植与支架植入的分站式杂交手术.患者的年龄为56.7±9.6岁,其中男性32例,女性3例;冠脉双支病变10例,三支病变25例,冠脉病变支数2.7±0.5支.首先完成机器人辅助下内乳动脉游离和非体外循环下、内乳动脉到前降支的吻合,术后2周内行其余病变冠脉的支架植入术,支架植入同期造影检查桥血管的通畅性.术后6个月、1至5年时复查64排CT,明确动脉桥血管和支架的通畅性,随访主要心脏不良事件(MACE)包括心源性死亡、急性心肌梗死和靶病变再次血运重建的发生率.结果所有患者均顺利接受分站式杂交手术,无并发症发生.平均动脉桥血流量为36.0±22.5 mL/min,支架植入时动脉桥血管造影检查通畅率为100%.35例患者共植入49枚支架,植入1.34±0.6枚,其中23例患者植入支架1枚,11例植入2枚,1例植入3枚.无失访患者,随访时间6~62(17.5±11.6)月.术后6个月时桥血管和支架内闭塞各1例,但无临床症状,其余患者桥血管及支架保持通畅,无心绞痛及MACE事件发生.结论机器人冠状动脉旁路移植联合支架植入的分站式杂交有良好的近期桥血管和支架通畅率,是一种可供选择的治疗多支冠脉病变的微创方案.
목적 총결궤기인관상동맥방로이식여지가식입적잡교수술근기림상결과.방법 2007년1월~2013년5월,35례환자접수기인관상동맥방로이식여지가식입적분참식잡교수술.환자적년령위56.7±9.6세,기중남성32례,녀성3례;관맥쌍지병변10례,삼지병변25례,관맥병변지수2.7±0.5지.수선완성궤기인보조하내유동맥유리화비체외순배하、내유동맥도전강지적문합,술후2주내행기여병변관맥적지가식입술,지가식입동기조영검사교혈관적통창성.술후6개월、1지5년시복사64배CT,명학동맥교혈관화지가적통창성,수방주요심장불량사건(MACE)포괄심원성사망、급성심기경사화파병변재차혈운중건적발생솔.결과 소유환자균순리접수분참식잡교수술,무병발증발생.평균동맥교혈류량위36.0±22.5 mL/min,지가식입시동맥교혈관조영검사통창솔위100%.35례환자공식입49매지가,식입1.34±0.6매,기중23례환자식입지가1매,11례식입2매,1례식입3매.무실방환자,수방시간6~62(17.5±11.6)월.술후6개월시교혈관화지가내폐새각1례,단무림상증상,기여환자교혈관급지가보지통창,무심교통급MACE사건발생.결론 궤기인관상동맥방로이식연합지가식입적분참식잡교유량호적근기교혈관화지가통창솔,시일충가공선택적치료다지관맥병변적미창방안.
To assess the short-term outcomes of staged hybrid coronary revascularization performed using robotic-assisted off-pump coronary bypass grafting followed by percutaneous coronary intervention (PCI) in a non-left anterior descending (LAD) coronary artery lesion. Methods From January, 2007 to May, 2013, 35 patients (32 male and 3 female patients, mean age 56.7 ± 9.6 years) underwent staged hybrid coronary revascularization. Ten patients had double-vessel and 25 patients had triple-vessel coronary diseases, and the lesions involved an average of 2.7 ± 0.5 coronary vessels. Coronary artery bypass grafting was completed in robotic-assisted left internal thoracic artery (ITA) harvesting and LITA to LAD bypass. Coronary angiography or 64-MSCT was performed to evaluate the patency of the ITA and stents at 6 months and at 1 to 5 years postoperatively. The patients were followed for major adverse cardiac events (MACE) including cardiac death, acute myocardial infarction and target lesion revascularization. Results Staged hybrid revascularization was completed successfully in all the patients without complications. The LITA to LAD anastomosis was completed in minimally invasive direct coronary bypass grafting (MIDCAB) or totally robotic coronary bypass grafting on beating heart (TECAB) with the assistance of da Vinci Surgical System. The mean artery graft flow was 36.0±22.5 ml/min, and the graft had a 100%patency before discharge. A total of 49 stents were deployed in 35 patients within 2 weeks after robotic coronary bypass grafting, with a mean of 1.34±0.6 stents per case (1 stent in 23 cases, 2 stents in 11 cases, and 3 stents in 1 case). The patients were followed up for 17.5 ± 11.6 months, and 1 patient had artery graft occlusion and another had in-stent occlusion at 6 months. All the other 33 patients had patent LITA-to-LAD anastomosis without angina or MACE. Conclusion Staged hybrid revascularization strategy has acceptable angiographic patency results for both LITA-LAD grafts and PCI interventions.