Ishida Toru, Kurosawa Hiromi, Nishida Hiroshi, Aomi Shigeyuki, Endo Masahiro
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Jpn J Thorac Cardiovasc Surg. 2003 Jul;51(7):277-81. doi: 10.1007/BF02719378.
Since 1989, we have applied the right gastroepiploic artery (RGEA) as a third arterial conduit for coronary artery bypass grafting (CABG) and started to use sequential RGEA in 1992. We evaluated the feasibility and efficacy of sequential RGEA grafting in CABG.
From December 1990 to January 2000, 46 patients underwent CABG with sequential RGEA. There were 42 male and 4 female patients with a mean age of 59 +/- 8.1 years. Mean postoperative follow-up period was 70 months.
The mean number of anastomoses was 3.7 per patient. Mean luminal diameter of the RGEA was 2.2 +/- 0.4 mm by preoperative angiography and 2.3 +/- 0.6 mm by intraoperative measurement. Patency of the sequential RGEA was 92%; proximal anastomosis 100%, distal anastomosis 86% (p = 0.01). The 5-year actuarial survival and cardiac event-free rate were 91% and 93%, respectively.
Sequential bypass using the RGEA is feasible, with excellent early and long-term results. The indication for sequential RGEA, however, needs careful anatomical consideration of both the luminal diameter of the RGEA and proximal stenosis of the target coronary arteries.
自1989年起，我们将胃网膜右动脉（RGEA）作为冠状动脉旁路移植术（CABG）的第三条动脉血管，并于1992年开始使用序贯式胃网膜右动脉。我们评估了序贯式胃网膜右动脉移植术在冠状动脉旁路移植术中的可行性和疗效。
1990年12月至2000年1月，46例患者接受了序贯式胃网膜右动脉冠状动脉旁路移植术。其中男性42例，女性4例，平均年龄59±8.1岁。术后平均随访时间为70个月。
每位患者平均吻合口数量为3.7个。术前血管造影显示胃网膜右动脉平均管腔直径为2.2±0.4mm，术中测量为2.3±0.6mm。序贯式胃网膜右动脉通畅率为92%；近端吻合口通畅率为100%，远端吻合口通畅率为86%（p=0.01）。5年实际生存率和无心脏事件发生率分别为91%和93%。
使用胃网膜右动脉进行序贯旁路移植术是可行的，具有良好的早期和长期效果。然而，序贯式胃网膜右动脉的应用指征需要仔细考虑胃网膜右动脉的管腔直径和靶冠状动脉近端狭窄情况。
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