Muneretto Claudio, Bisleri Gianluigi, Negri Alberto, Manfredi Jacopo, Metra Marco, Nodari Savina, Culot Lidia, Dei Cas Livio
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
Circulation. 2003 Sep 9;108 Suppl 1:II29-33. doi: 10.1161/01.cir.0000087941.75337.f5.
Total arterial myocardial revascularization with composite grafts proved to enhance the long-term benefits of coronary surgery. We assessed the hypothesis that full arterial revascularization (FAR) may improve clinical outcome even in elderly and at short term.
A prospective randomized study was designed to compare FAR with conventional coronary artery bypass grafting (CABG) surgery [left interval thoracic artery (LITA) on left anterior descending (LAD) plus additional saphenous vein grafts] with the following end points: early and late death, graft occlusion, reintervention, angina recurrence, and acute myocardial infarction (AMI). We enrolled 200 consecutive patients >70 years of age; population was equally divided at random in Group 1 (G1, FAR) and Group 2 (G2, Conventional). The groups resulted comparable with respect to all preoperative continuous and discrete variables and risk factors (Euroscore: G1=8.4 versus G2=8.1). No differences between G1 versus G2 were observed in terms of postoperative complications (perioperative AMI:2% versus 3%), mean intensive care unit (ICU) (hours: 39+/-11 versus 40+/-9) and hospital stay (days: 6+/-2 versus 7+/-3) nor were there any differences in hospital mortality(G1=5% versus G2=4%). At the mean follow-up of 14+/-5 months the incidence of angina recurrence was 3% in G1 versus 12% in G2. Angiographic controls of grafts showed a superior graft patency rate of all the arterial grafts when compared with saphenous vein grafts. Conventional CABG surgery was identified as incremental risk factor for angina recurrence and as predictor for graft occlusion.
Total arterial myocardial revascularization improved clinical outcome of patients undergoing coronary surgery in the elderly, whereas saphenous vein grafts negatively affected patient prognosis in terms of graft patency and freedom from late cardiac events.
采用复合移植物进行全动脉心肌血运重建已被证明可提高冠状动脉手术的长期效益。我们评估了这样一个假设，即即使在老年患者中且在短期内，全动脉血运重建（FAR）也可能改善临床结局。
一项前瞻性随机研究旨在比较FAR与传统冠状动脉旁路移植术（CABG）手术[左前降支（LAD）采用左胸廓内动脉（LITA）加其他大隐静脉移植物]，观察以下终点：早期和晚期死亡、移植物闭塞、再次干预、心绞痛复发以及急性心肌梗死（AMI）。我们纳入了200例连续的70岁以上患者；将患者随机平均分为第1组（G1，FAR）和第2组（G2，传统手术组）。两组在所有术前连续和离散变量及危险因素方面具有可比性（欧洲心脏手术风险评估系统评分：G1 = 8.4对G2 = 8.1）。G1组与G2组在术后并发症（围手术期AMI：2%对3%）、平均重症监护病房（ICU）时长（小时：39±11对40±9）和住院时间（天：6±2对7±3）方面未观察到差异，医院死亡率也无差异（G1 = 5%对G2 = 4%）。在平均14±5个月的随访中，G1组心绞痛复发率为3%，G2组为12%。移植物的血管造影检查显示，与大隐静脉移植物相比，所有动脉移植物的通畅率更高。传统CABG手术被确定为心绞痛复发的增量危险因素和移植物闭塞的预测因素。
全动脉心肌血运重建改善了老年冠状动脉手术患者的临床结局，而大隐静脉移植物在移植物通畅性和避免晚期心脏事件方面对患者预后产生了负面影响。
