Theresia Feline Husen, Silke van Genechten, Jade Claessens, Loren Packlé, Samuel Heuts, Jos G Maessen, Alaaddin Yilmaz
{"title":"y型移植物与原位双侧乳腺内动脉在内镜下冠状动脉搭桥术中的对比。","authors":"Theresia Feline Husen, Silke van Genechten, Jade Claessens, Loren Packlé, Samuel Heuts, Jos G Maessen, Alaaddin Yilmaz","doi":"10.1177/15569845251377059","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The clinical outcomes of bilateral internal mammary arteries (BIMA) in situ were compared with Y-grafts in endoscopic coronary artery bypass grafting (endo-CABG), a less-invasive alternative to conventional CABG, providing reduced trauma and faster recovery.</p><p><strong>Methods: </strong>A retrospective single-center study was performed from January 2016 until February 2023 on endo-CABG patients, dividing them into in situ BIMA graft or Y-graft recipients. As endo-CABG was performed in all patients requiring surgical revascularization, this represents an unselected cohort. The primary outcome comprised freedom from major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were target lesion revascularization (TLR) and 1-year overall survival.</p><p><strong>Results: </strong>A total of 1,328 endo-CABG patients (BIMA in situ, <i>n</i> = 693; Y-graft, <i>n</i> = 634) were included. Overall, characteristics of both groups were comparable, except that Y-graft patients had more comorbidities (diabetes mellitus and myocardial infarction), which was reflected in the EuroSCORE II. Furthermore, most Y-graft patients had triple-vessel disease and a higher number of bypasses required. The 1-year MACCE-free survival did not differ significantly between the groups (91.9% vs 89%; univariable hazard ratio [HR] = 1.42, 95% CI: 0.96 to 2.11, <i>P</i> = 0.079; multivariable HR = 1.07, 95% CI: 0.70 to 1.63, <i>P</i> = 0.771), as did the 1-year survival rate (95.7% vs 93.2%; univariable HR = 1.67, 95% CI: 1.01 to 2.75, <i>P</i> = 0.046; multivariable HR =1.34, 95% CI: 0.77 to 2.33, <i>P</i> = 0.297). TLR did not differ significantly between groups (univariable HR = 0.68, 95% CI: 0.22 to 2.08, <i>P</i> = 0.499) or after adjustment (multivariable HR = 0.31, 95% CI: 0.08 to 1.24, <i>P</i> = 0.100).</p><p><strong>Conclusions: </strong>Creating a Y-graft for distal lesions and in cases in which more than 2 anastomoses are required serves as a favorable alternative without a difference between in situ and Y-grafts in 1-year MACCE-free survival.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845251377059"},"PeriodicalIF":1.6000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Y-Graft Versus In Situ Bilateral Internal Mammary Arteries in Endoscopic Coronary Artery Bypass Grafting.\",\"authors\":\"Theresia Feline Husen, Silke van Genechten, Jade Claessens, Loren Packlé, Samuel Heuts, Jos G Maessen, Alaaddin Yilmaz\",\"doi\":\"10.1177/15569845251377059\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>The clinical outcomes of bilateral internal mammary arteries (BIMA) in situ were compared with Y-grafts in endoscopic coronary artery bypass grafting (endo-CABG), a less-invasive alternative to conventional CABG, providing reduced trauma and faster recovery.</p><p><strong>Methods: </strong>A retrospective single-center study was performed from January 2016 until February 2023 on endo-CABG patients, dividing them into in situ BIMA graft or Y-graft recipients. As endo-CABG was performed in all patients requiring surgical revascularization, this represents an unselected cohort. The primary outcome comprised freedom from major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were target lesion revascularization (TLR) and 1-year overall survival.</p><p><strong>Results: </strong>A total of 1,328 endo-CABG patients (BIMA in situ, <i>n</i> = 693; Y-graft, <i>n</i> = 634) were included. Overall, characteristics of both groups were comparable, except that Y-graft patients had more comorbidities (diabetes mellitus and myocardial infarction), which was reflected in the EuroSCORE II. Furthermore, most Y-graft patients had triple-vessel disease and a higher number of bypasses required. The 1-year MACCE-free survival did not differ significantly between the groups (91.9% vs 89%; univariable hazard ratio [HR] = 1.42, 95% CI: 0.96 to 2.11, <i>P</i> = 0.079; multivariable HR = 1.07, 95% CI: 0.70 to 1.63, <i>P</i> = 0.771), as did the 1-year survival rate (95.7% vs 93.2%; univariable HR = 1.67, 95% CI: 1.01 to 2.75, <i>P</i> = 0.046; multivariable HR =1.34, 95% CI: 0.77 to 2.33, <i>P</i> = 0.297). TLR did not differ significantly between groups (univariable HR = 0.68, 95% CI: 0.22 to 2.08, <i>P</i> = 0.499) or after adjustment (multivariable HR = 0.31, 95% CI: 0.08 to 1.24, <i>P</i> = 0.100).</p><p><strong>Conclusions: </strong>Creating a Y-graft for distal lesions and in cases in which more than 2 anastomoses are required serves as a favorable alternative without a difference between in situ and Y-grafts in 1-year MACCE-free survival.</p>\",\"PeriodicalId\":13574,\"journal\":{\"name\":\"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery\",\"volume\":\" \",\"pages\":\"15569845251377059\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/15569845251377059\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15569845251377059","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较双侧原位乳内动脉（BIMA）与y型移植物在内镜下冠状动脉旁路移植术（内镜下冠状动脉旁路移植术）中的临床效果，内镜下冠状动脉旁路移植术是一种微创的替代方法，创伤小，恢复快。方法：2016年1月至2023年2月，对内镜下cabg患者进行回顾性单中心研究，将其分为原位BIMA受体和y -受体。由于所有需要手术血运重建术的患者都进行了腔内冠脉搭桥，因此这是一个未选择的队列。主要终点包括无主要心脑血管不良事件（MACCE）。次要结果是靶病变血运重建术（TLR）和1年总生存期。结果：共纳入1328例endo-CABG患者（原位BIMA， 693例；Y-graft， 634例）。总的来说，两组的特征是相似的，除了y -移植物患者有更多的合并症（糖尿病和心肌梗死），这在EuroSCORE II中有所反映。此外，大多数y型移植物患者患有三支血管疾病，需要更多的旁路手术。组间1年无macce生存率无显著差异（91.9% vs 89%；单变量风险比[HR] = 1.42, 95% CI: 0.96 ~ 2.11, P = 0.079；多变量风险比[HR] = 1.07, 95% CI: 0.70 ~ 1.63, P = 0.771）， 1年生存率也无显著差异（95.7% vs 93.2%；单变量风险比= 1.67,95% CI: 1.01 ~ 2.75, P = 0.046；多变量风险比=1.34,95% CI: 0.77 ~ 2.33, P = 0.297）。各组间TLR差异无统计学意义（单变量HR = 0.68, 95% CI: 0.22 ~ 2.08, P = 0.499）或调整后（多变量HR = 0.31, 95% CI: 0.08 ~ 1.24, P = 0.100）。结论：对于远端病变和需要2个以上吻合口的病例，创建y型移植物是一种有利的选择，在1年无macce生存期中，原位移植和y型移植物没有区别。
Y-Graft Versus In Situ Bilateral Internal Mammary Arteries in Endoscopic Coronary Artery Bypass Grafting.
Objective: The clinical outcomes of bilateral internal mammary arteries (BIMA) in situ were compared with Y-grafts in endoscopic coronary artery bypass grafting (endo-CABG), a less-invasive alternative to conventional CABG, providing reduced trauma and faster recovery.
Methods: A retrospective single-center study was performed from January 2016 until February 2023 on endo-CABG patients, dividing them into in situ BIMA graft or Y-graft recipients. As endo-CABG was performed in all patients requiring surgical revascularization, this represents an unselected cohort. The primary outcome comprised freedom from major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were target lesion revascularization (TLR) and 1-year overall survival.
Results: A total of 1,328 endo-CABG patients (BIMA in situ, n = 693; Y-graft, n = 634) were included. Overall, characteristics of both groups were comparable, except that Y-graft patients had more comorbidities (diabetes mellitus and myocardial infarction), which was reflected in the EuroSCORE II. Furthermore, most Y-graft patients had triple-vessel disease and a higher number of bypasses required. The 1-year MACCE-free survival did not differ significantly between the groups (91.9% vs 89%; univariable hazard ratio [HR] = 1.42, 95% CI: 0.96 to 2.11, P = 0.079; multivariable HR = 1.07, 95% CI: 0.70 to 1.63, P = 0.771), as did the 1-year survival rate (95.7% vs 93.2%; univariable HR = 1.67, 95% CI: 1.01 to 2.75, P = 0.046; multivariable HR =1.34, 95% CI: 0.77 to 2.33, P = 0.297). TLR did not differ significantly between groups (univariable HR = 0.68, 95% CI: 0.22 to 2.08, P = 0.499) or after adjustment (multivariable HR = 0.31, 95% CI: 0.08 to 1.24, P = 0.100).
Conclusions: Creating a Y-graft for distal lesions and in cases in which more than 2 anastomoses are required serves as a favorable alternative without a difference between in situ and Y-grafts in 1-year MACCE-free survival.
期刊介绍：
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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