动脉移植物在冠状动脉血运重建中的应用。2987例吻合术的经验。

Use of arterial grafts for coronary revascularization. Experience of 2987 anastomoses.

作者信息

Tomizawa Y, Endo M, Nishida H, Niinami H, Tanaka S, Tomioka H, Ozawa H, Kikuchi C, Koyanagi H

机构信息

Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan.

出版信息

Jpn J Thorac Cardiovasc Surg. 1999 Jul;47(7):325-9. doi: 10.1007/BF03218019.

DOI:10.1007/BF03218019

PMID:10481390

Abstract

OBJECTIVES

The aim of this study was to evaluate the performance and the quality of arterial grafts for coronary artery bypass grafting at The Heart Institute of Japan, Tokyo Women's Medical University.

PATIENTS AND METHODS

From January 1970 to March 1998, 2987 arterial grafts, including left and right internal thoracic arteries, gastroepiploic artery, radial artery and inferior epigastric artery, were used in 1673 patients. In the same period, 1225 saphenous vein grafts were used. Early graft patency was angiographically determined. Also, histological evaluation of operative specimens and preoperative angiographic evaluation of arterial grafts were performed.

RESULTS

The total number of hospital deaths was 38 (2.3%). Of 4212 grafts, 3919 grafts (93%) were evaluated angiographically and 3714 of 3919 grafts were patent (94.8%). The patency rate of internal thoracic artery was better than that of gastroepiploic artery (p < 0.0001), radial artery (p = 0.0005) and saphenous vein grafts (p < 0.0001). However, the patency rate of gastroepiploic artery was better than that of saphenous vein grafts (p = 0.04), while no significant difference was detected between gastroepiploic artery and rdial artery. Only one internal thoracic artery specimen obtained at surgery showed atherosclerotic change, but all gastroepiploic artery specimens had moderate to severe atherosclerotic changes with CD68-positive cell infiltration. Only one patient's left internal thoracic artery out of 200 was not angiographically useable as a conduit, while multiple stenotic lesions in gastroepiploic artery were observed.

CONCLUSIONS

In the graft selection for CABG, the primary choice is internal thoracic artery and the secondary choice is right internal thoracic artery, from the standpoint of histological and angiographic evaluation, gastroepiploic artery and/or radial artery, depending on the target anastomotic site, degree of stenosis, and in situ or free use is the third choice.

摘要

目的

本研究旨在评估东京女子医科大学日本心脏研究所冠状动脉搭桥术中动脉移植物的性能和质量。

患者与方法

1970年1月至1998年3月，1673例患者使用了2987根动脉移植物，包括左、右胸廓内动脉、胃网膜动脉、桡动脉和腹壁下动脉。同期使用了1225根大隐静脉移植物。通过血管造影确定早期移植物通畅情况。此外，还对手术标本进行了组织学评估，并对动脉移植物进行了术前血管造影评估。

结果

医院死亡总数为38例（2.3%）。在4212根移植物中，3919根移植物（93%）接受了血管造影评估，其中3714根移植物通畅（94.8%）。胸廓内动脉的通畅率优于胃网膜动脉（p < 0.0001）、桡动脉（p = 0.0005）和大隐静脉移植物（p < 0.0001）。然而，胃网膜动脉的通畅率优于大隐静脉移植物（p = 0.04），而胃网膜动脉和桡动脉之间未检测到显著差异。手术中获取的仅1例胸廓内动脉标本显示有动脉粥样硬化改变，但所有胃网膜动脉标本均有中度至重度动脉粥样硬化改变及CD68阳性细胞浸润。200例患者中仅1例患者的左胸廓内动脉在血管造影时不能用作管道，而胃网膜动脉观察到多处狭窄病变。