Muneretto Claudio, Negri Alberto, Manfredi Jacopo, Terrini Alberto, Rodella Giulia, Elqarra Suad, Bisleri Gianluigi
Department of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
J Thorac Cardiovasc Surg. 2003 Apr;125(4):826-35. doi: 10.1067/mtc.2003.154.
To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization.
Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors.
There were no differences between group 1 and group 2 in terms of the number of grafted vessels (mean, 2.8 vs 2.9, respectively), crossclamping time (mean, 38 +/- 7 vs 40 +/- 6 min, respectively), intensive care unit stay (mean, 25 +/- 8 vs 24 +/- 7 hours, respectively), and hospital mortality (1% in both groups) nor were there any differences in postoperative complications. At the mean follow-up of 12 +/- 4 months, patients receiving total arterial revascularization (group 1) showed a better outcome in terms of angina recurrence (group 1 vs group 2: 2 vs 13 patients, P =.007), need of percutaneous transluminal coronary angioplasty reintervention (group 1 vs group 2: 0 vs 8 patients, P =.0012), and actuarial freedom from cardiac events (group 1 vs group 2: 96% vs 67%, P =.006). Angiography carried out in 72% in group 1 and in 68% in group 2 demonstrated a patency rate of 99% of saphenous vein grafts in group 1 and 89% of saphenous grafts in group 2.
Total myocardial revascularization with composite arterial grafts provided superior clinical results and improved patient outcome, even in the short term to midterm. Arterial conduit-related benefits were clearly evident with respect to recurrence of angina and a higher graft patency rate.
为了评估与传统冠状动脉手术结果相比，使用复合移植物进行完全动脉血运重建的结果，我们纳入了连续200例接受心肌血运重建的患者。
患者被随机分为两组，每组100例：第1组接受完全动脉血运重建，第2组接受左内乳动脉至左前降支搭桥术加额外的大隐静脉移植物。两组在连续和离散变量以及术前危险因素方面具有可比性。
第1组和第2组在移植血管数量（分别为平均2.8支和2.9支）、主动脉阻断时间（分别为平均38±7分钟和40±6分钟）、重症监护病房停留时间（分别为平均25±8小时和24±7小时）以及医院死亡率（两组均为1%）方面没有差异，术后并发症也没有差异。在平均12±4个月的随访中，接受完全动脉血运重建的患者（第1组）在心绞痛复发（第1组与第2组：2例与13例患者，P = 0.007）、经皮冠状动脉腔内血管成形术再次干预需求（第1组与第2组：0例与8例患者，P = 0.0012）以及无心脏事件生存率（第1组与第2组：96%与67%，P = 0.006）方面显示出更好的结果。第1组72%和第2组68%的患者进行了血管造影，结果显示第1组大隐静脉移植物通畅率为99%，第2组大隐静脉移植物通畅率为89%。
即使在短期至中期，使用复合动脉移植物进行完全心肌血运重建也能提供更好的临床结果并改善患者预后。在心绞痛复发和更高的移植物通畅率方面，动脉管道相关的益处明显。
