Laub G W, Muralidharan S, Clancy R, Eldredge W J, Chen C, Adkins M S, Fernandez J, Anderson W A, McGrath L B
Division of Cardiothoracic Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015.
Ann Thorac Surg. 1992 Nov;54(5):826-31. doi: 10.1016/0003-4975(92)90632-e.
Traditional autologous conduits are sometimes unavailable or unsuitable to permit total revascularization during coronary artery bypass grafting. In these patients the results of using nonautologous alternative conduits has been disappointing. Encouraged by the excellent long-term results seen with cryopreserved allograft valves, a clinical protocol was developed to evaluate the use of a commercially cryopreserved allograft saphenous vein (CPV). Our protocol consisted of using CPV when left internal mammary arteries and autologous saphenous vein grafts were unavailable or unsuitable for complete revascularization. Blood group (ABO) typed CPVs were thawed and implanted as required using standard surgical techniques. From December 1989 through June 1991, 19 of 1,602 patients who underwent coronary revascularization had CPVs implanted (1.2%). There were no operative deaths. An attempt was made to evaluate the patency of all grafts with coronary arteriography or ultrafast computed tomographic scans. Fourteen patients were available for patency evaluation. Patency rate in the 14 patients studied at a mean of 7 +/- 2 months (range, 2 to 16 months) were: internal mammary artery, 93% (14/15); saphenous vein graft, 80% (4/5); and CPV, 41% (7/17). The patency of the CPV was significantly less than the patency rate for the saphenous vein and internal mammary artery (p = 0.004). We conclude that the short-term patency rate of CPVs is inferior to that of autologous vessels. Due to its poor patency, we recommend that CPV should only be used when no other autologous conduit is available.
传统的自体血管有时无法获取或不适合在冠状动脉旁路移植术中实现完全血运重建。在这些患者中，使用非自体替代血管的效果一直不尽人意。受冷冻保存同种异体瓣膜长期出色效果的鼓舞，我们制定了一项临床方案来评估商业冷冻保存同种异体大隐静脉（CPV）的使用情况。我们的方案是在左乳内动脉和自体大隐静脉移植物无法获取或不适合进行完全血运重建时使用CPV。根据血型（ABO）分型的CPV解冻后，按照标准手术技术按需植入。从1989年12月至1991年6月，1602例接受冠状动脉血运重建的患者中有19例植入了CPV（1.2%）。无手术死亡病例。我们试图通过冠状动脉造影或超快速计算机断层扫描评估所有移植物的通畅情况。14例患者可进行通畅性评估。在平均7±2个月（范围为2至16个月）接受研究的14例患者中，通畅率分别为：乳内动脉93%（14/15）；大隐静脉移植物80%（4/5）；CPV 41%（7/17）。CPV的通畅率显著低于大隐静脉和乳内动脉的通畅率（p = 0.004）。我们得出结论，CPV的短期通畅率低于自体血管。由于其通畅性较差，我们建议仅在没有其他自体血管可用时才使用CPV。
