Uchikawa S, Nishida H, Endo M, Chikazawa G, Ozawa H, Yamazaki K, Kawai A, Tomizawa Y, Aomi S, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medial University, Tokyo, Japan.
Kyobu Geka. 2002 Nov;55(12):1006-10.
From March 1996 to May 2000, 41 patients [age 39-78 (mean 63.5 +/- 8.8) years, 90.2% male] underwent all arterial multiple coronary artery bypass grafting (CABG) using bilateral internal thoracic (BiITA) and radial (RA) arterial conduits. The reason for using RA was that the right gastroepiploic artery (RGEA) was small or occluded on preoperative angiography, a history of upper abdominal surgery or disease, or the right coronary arterial lesion was proximal and mild. The BiITA were used as in situ grafts and the proximal anastomosis of RA was to the ascending aorta in all cases. All patients underwent conventional elective CABG with median sternotomy using cardiopulmonary bypass. The mean number of anastomoses was 3.3 +/- 0.5 branches and complete revascularization rate was 80.5%. Postoperative follow-up averaged 20 months and the longest was 50 months. There was no early death, and overall graft patency 2-3 weeks after surgery was 96.2% (LITA 94.0%, RITA 97.6%, RA 97.6%). Four-year actuarial survival rate was 96.4 +/- 3.5% (1 patient: 9 months, no cardiac death), and cardiac event-free rate after surgery was 89.7 +/- 4.9% [4 patients: percutaneous transluminal coronary angioplasty (PTCA)]. However, once patients were discharged from hospital, cardiac event-free rate was 100%. These excellent results suggest that all arterial graft CABG was satisfactory, and RA can be used as a third suitable arterial bypass conduit, if RGEA cannot be used or is unsuitable for use.
1996年3月至2000年5月，41例患者[年龄39 - 78岁（平均63.5±8.8岁），男性占90.2%]接受了使用双侧胸廓内动脉（BiITA）和桡动脉（RA）作为动脉移植物的全动脉化多支冠状动脉旁路移植术（CABG）。使用RA的原因是术前血管造影显示右胃网膜动脉（RGEA）细小或闭塞、有上腹部手术或疾病史，或者右冠状动脉病变位于近端且较轻。所有病例中，BiITA均作为原位移植物使用，RA的近端吻合口均位于升主动脉。所有患者均采用正中胸骨切开术，在体外循环辅助下进行常规择期CABG。平均吻合支数为3.3±0.5支，完全血运重建率为80.5%。术后平均随访20个月，最长随访50个月。无早期死亡病例，术后2 - 3周时总体移植物通畅率为96.2%（左胸廓内动脉94.0%，右胸廓内动脉97.6%，桡动脉97.6%）。4年精算生存率为96.4±3.5%（1例患者：9个月，无心脏死亡），术后无心脏事件发生率为89.7±4.9%[4例患者：经皮冠状动脉腔内血管成形术（PTCA）]。然而，一旦患者出院，无心脏事件发生率为100%。这些优异的结果表明，全动脉化移植物CABG效果令人满意，如果不能使用或不适合使用RGEA，RA可作为第三条合适的动脉旁路移植物。
