Nishida H, Hirota J, Koyanagi T, Abe R, Nakano K, Endo M, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Kyobu Geka. 1992 Jul;45(8 Suppl):660-4.
To analyze and compare the effects of saphenous vein grafts (SVG) and arterial grafts (AG) on the long-term results of the coronary artery bypass grafting (CABG), retrospective nonrandomized studies were performed in 1,400 consecutive patients with CABG in terms of reoperation, postoperative transluminal coronary angioplasty (PTCA) to the grafts, actuarial survival rate, and cumulative event free rate. AG was used frequently in recent cases in which more diffuse and multiple vessel disease were encountered. No statistically significant differences were noted in any of the reoperation free rate, actuarial survival rate, success rate of the PTCA, and cumulative event free rate between SVG and AG, because the long-term results of the SVG was apparently better than reported Caucasian's long-term results, while those of the AG were as good as Caucasian's. Reoperation and PTCA for the AG were performed less than one year after the CABG in most cases and restenosis after the PTCA was rare. In contrast, those for the SVG were mainly done late postoperative period, and the incidence of the restenosis after the PTCA was very high. These results indicated that the main cause of the graft failure in the AG was technic-related, and that of the SVG was graft's atherosclerosis. We conclude from this study that AG should be indicated more extensively than SVG, but proper indication and application of the AG in various situations and technical improvement to avoid stenosis at anastomosis are important to improve the long-term results of the CABG.
为分析和比较大隐静脉移植物（SVG）和动脉移植物（AG）对冠状动脉旁路移植术（CABG）长期效果的影响，我们对1400例连续接受CABG的患者进行了回顾性非随机研究，内容包括再次手术、对移植物进行术后腔内冠状动脉成形术（PTCA）、精算生存率和累积无事件发生率。在近期遇到更弥漫性和多支血管病变的病例中，AG的使用更为频繁。SVG和AG在再次手术免发生率、精算生存率、PTCA成功率和累积无事件发生率方面均未发现统计学上的显著差异，因为SVG的长期效果明显优于所报道的白种人的长期效果，而AG的长期效果与白种人的相当。大多数情况下，AG的再次手术和PTCA在CABG后不到一年进行，PTCA后再狭窄很少见。相比之下，SVG的再次手术和PTCA主要在术后晚期进行，PTCA后再狭窄的发生率非常高。这些结果表明，AG移植物失败的主要原因与技术相关，而SVG的主要原因是移植物动脉粥样硬化。我们从这项研究得出结论，AG的适应证应比SVG更广泛，但在各种情况下正确选择AG的适应证和应用方法以及改进技术以避免吻合口狭窄，对于提高CABG的长期效果很重要。
