| Background and ObjectiveCoronary heart disease(CAD)refers to coronary artery stenosis,insufficiency caused by myocardial dysfunction and / or organic disease,So also called ischemic heart disease(IHD).Coronary heart disease(CAD)is one of the most common cardiovascular problems with disability and mortality.Its pathogenesis and coronary artery atherosclerosis lesions are closely related,but its scope is more extensive,Which also includes inflammation,vascular functional changes(such as vasospasm),embolism caused by stenosis or occlusion.Over the years with the continuous development of scientific research and medical technology,for the new concept of coronary heart disease(CAD)treatment,new methods are endless,but how to obtain reliable and effective revascularization is still the core of the treatment.Coronary Artery Bypass Grafting(CABG)is a great achievement in the history of human medicine in the 20 th century.In the next half a century,accompanied by anesthesia,cardiopulmonary bypass and the rapid development of minimally invasive technology,making this surgical method more secure and reliable,by the majority of doctors and patients recognized and accepted.To date,coronary artery bypass grafting(CABG)remains one of the most effective treatments for coronary heartdisease(CAD).However,in recent years,percutaneous coronary intervention(PCI)treatment because of its ease of operation,the risk is relatively small,short recovery time and emergency situations can quickly make blood vessels,blood vessels and many other advantages of rapid development,has also been widely used In clinical.This has created a huge challenge forCABG.Although the current treatment of coronary artery disease and the choice of surgery,the pros and cons of CABG and PCI has been the focus of internal and surgical debate,However,according to the European Society of Cardiology(ESC)/ European Cardiothoracic Surgery Association(EACTS)guidelines,the traditional CABG is still the gold standard for the treatment of coronary artery multiple lesions and complex anterior descending artery stenosis.CABG transplantation of vascular selection for the success of the operation as well as the long-term effect is essential.At present,the clinical use of coronary artery bypass graft(CABG)in the vein graft is mainly the great saphenous vein(SVG);arterial grafts are: left internal mammary artery(LIMA),radial artery(RA),gastric Arteries(GEA),right internal mammary artery(RIMA)and so on.There are other vascular grafts as a bridge reported,artificial vascular bridge is also actively studied.As a result of grafting blood vessels,arteries and venous blood vessels,their main advantages are excellent long-term openness.Among them,the use of left internal mammary artery(LIMA)and left anterior descending artery(LAD)anastomosis method is most commonly used by the surgeon,its good long-term effect has been widely recognized.And in the current ESC / EACTS Cardiovascular Revascularization Guidelines,the use of LIMA for the left anterior descending artery LAD is the only class I recommendation for CABG grafts.For the internal control of the internal mammary artery(IMA),the current clinical pediatric pedicle(Pedicled)and skeleton of the skeleton(skeletonized)two free technology.The main advantage of the pedicle method is the convenience of the material,and because of this,it is more widely used in clinical practice.But its shortcomings are more obvious.Surgery need to separate more of the perivascular tissue,leading to greater brachialis under the wound,thus affecting the sternal blood supply;at the same time in the length of the transplanted vascular bridge also has some restrictions.In contrast,the skeletal dissociation can ensure the maximum length of the grafted vascular bridge,increase the blood flow of the bridge blood vessels,and maximize the retention of sternal blood supply.However,this method of surgical methods require a higher surgical technique,surgery to obtain a longer time,the incidence of internal mammary artery injury is higher.Out of these problems may affect the consideration of surgical results,cardiac surgeons tend to ignore the advantages of skeletal free internal mammary artery for CABG,which largely limits its application in clinical practice.In this study,we compared the effects of pedicled and skeletal free internal mammary artery on perioperative and postoperative outcomes in coronary artery bypass grafting(CABG),The expression of eNOS in the two internal arteries was observed by Western blot to compare the differences in vascular structural integrity.To provide a basis for encouraging the choice of free internal mammography in the surgery.Methods526 patients with coronary heart disease who underwent CABG were selected as research object at the First Affiliated Hospital of Zhengzhou University,January 2014 to June 2015.342 male and 184 female,aged from 38 to 76 years old(61.6± 8.5 years),were randomly divided into two groups,262 cases of group P who underwentsurgery with the use of pedicle internal mammary artery,264 cases in group S was used in the operation of skeletonized internal mammary artery.To observe the main postoperative complications,perioperative related indexes,and the incidence of adverse cardiovascular events(MACE)and bridge patency rate in the patients who were followed up for 1 year.In the two groups,3 specimens were randomly selected from the end of the internal mammary artery,and the expression of eNOS was observed by Western blot.ResultsThe surgery of 526 cases were successfully completed,which got 532 branch of internal mammary artery by the way of dissociation,namely 518 branch of the left internal mammary artery and 14 branch of right internal mammary artery,6 cases of patients were obtained bilateral internal mammary artery among them.Two groups of artery blood flow of operation indicated that group P was(22.8±7.8 ml/min)and group S was(41.6±8.3 ml/min),The difference was statistically significant(P<0.05).The time of P and S group for Free internal mammary artery was(18.1±5.5 min),(32.5±6.8 min)respectively,The difference was statistically significant(P<0.05).The total time of surgery that group P was(245±21 min)and group S was(252±18min),which have no statistical significance(P> 0.05).The length of free Internal mammary artery that group P was(13.5±0.8 cm)and group S was(15.8±0.9 cm),the difference was statistically significant(P<0.05).Perioperative death of group P was 4 cases(1.53%),while the group S was 5 cases(1.89%),which have no statistical significance(P> 0.05);12cases(4.58%)and 10 cases(3.78%)of the remaining cases of the two groups during perioperative period occured myocardial infarction,the difference have no statistically significance(P> 0.05).1cases of the two groups Sternal nonunion,the difference have no statistically significance(P> 0.05).All patients were followed up for 3 to 12 months,patency rate of artery graft of two groups for 1 years were 99.58% and 99.59% respectively,the difference have no statistically significance(P> 0.05).Western Blot showed no significant difference in eNOS expression between the two groups(P> 0.05).ConclusionIn CABG,the skeletonized and pedicled method of obtaining free internal mammary artery were no significant difference in recent results for perioperative and postoperative results.There was no significant difference in the structural integrity of the internal mammary artery between the two methods.Although the skeletal free technology has a certain technical difficulty,but because of it to a certain extent,overcome the Pediclfree internal mammary artery shortcomings.More important for patients with diabetes mellitus,older,or other patients who need to collect bilateral mammary arteries.So it should be popularized in clinical application. |
PDF Full Text Request