冠状动脉旁路移植术复合动脉移植物中桡动脉与右胃网膜动脉的随机对照研究。

Randomized comparative study of radial artery and right gastroepiploic artery in composite arterial graft for CABG.

作者信息

Santos G G, Stolf N A G, Moreira L F P, Haddad V L S, Simões R M C, Carvalho S R V, Salgado A A, Avelar S F

机构信息

H. Beneficência Portuguesa and Heart Institute, University of São Paulo, Rua Maestro Cardim 769, Brazil.

出版信息

Eur J Cardiothorac Surg. 2002 Jun;21(6):1009-14. doi: 10.1016/s1010-7940(02)00180-x.

DOI:10.1016/s1010-7940(02)00180-x

PMID:12048078

Abstract

OBJECTIVES

Arterial grafts have been used to achieve better long-term results and improve graft patency in coronary artery bypass grafting. Composite graft was proposed to overcome inconveniences of proximal anastomoses to the aorta and increase the use and surgical options of arterial grafts. However, lack of prospective randomized studies with this kind of grafts is evident. We compare the results of composite Y-grafts of the radial artery (RA) and the right gastroepiploic artery (RGEA) proximally anastomosed to the left internal thoracic artery (LITA) for CABG, evaluated through angiography, in a prospective randomized study.

METHODS

Between August 1998 and November 1999, 60 patients were randomly divided into two groups: group I (GI) received RGEA graft and group II (GII), RA graft. LITA was used to graft the left anterior descending artery and RGEA or RA was placed to obtuse marginal or first diagonal branch. The right coronary artery branches was grafted with saphenous vein graft (SVG) when necessary. All coronary arteries receiving arterial grafts had > or =75% proximal stenosis and diameter > or =1.5 mm.

RESULTS

GI and GII preoperative data were similar, 63 distal anastomoses were performed with the LITA, 32 with the RA and 32 with the RGEA. There were two perioperative deaths (3.3%), one in each group, none related to cardiac causes. Four (6.6%) q-wave myocardial infarctions were found and two (3.3%) patients showed low cardiac output syndrome. Angiography was performed in all surviving patients from the 8th to 15th postoperative day and showed a patency rate of 96.5% (56/58) for LITA, 89.6% (26/29) for RA and 68.9% (20/29) for RGEA, with a statistically significant difference between RGEA and RA (P=0.025).

CONCLUSIONS

Radial artery had better early results than right gastroepiploic artery. Use of the LITA as inflow graft seems not to affect its good patency. Use of the RGEA as composite graft should not be encouraged. Long-term follow-up with objective investigation and randomized trials is required to confirm better results of composite conduits.

摘要

目的

在冠状动脉旁路移植术中，动脉移植物已被用于获得更好的长期效果并提高移植物通畅率。复合移植物被提出以克服与主动脉近端吻合的不便之处，并增加动脉移植物的使用和手术选择。然而，显然缺乏关于此类移植物的前瞻性随机研究。在一项前瞻性随机研究中，我们比较了经血管造影评估的，近端与左乳内动脉（LITA）吻合的桡动脉（RA）和右胃网膜动脉（RGEA）的复合Y形移植物用于冠状动脉旁路移植术（CABG）的结果。

方法

1998年8月至1999年11月期间，60例患者被随机分为两组：第一组（GI）接受RGEA移植物，第二组（GII）接受RA移植物。LITA用于移植左前降支，RGEA或RA用于移植钝缘支或第一对角支。必要时，用大隐静脉移植物（SVG）移植右冠状动脉分支。所有接受动脉移植物的冠状动脉近端狭窄≥75%且直径≥1.5mm。

结果

GI和GII的术前数据相似，使用LITA进行了63次远端吻合，使用RA进行了32次，使用RGEA进行了32次。围手术期死亡2例（3.3%），每组各1例，均与心脏原因无关。发现4例（6.6%）q波心肌梗死，2例（3.3%）患者出现低心排血量综合征。术后第8至15天对所有存活患者进行了血管造影，结果显示LITA的通畅率为96.5%（56/58），RA为89.6%（26/29），RGEA为68.9%（20/29），RGEA与RA之间存在统计学显著差异（P=0.025）。