Farsak Bora, Tokmakoglu Hilmi, Kandemir Ozer, Günaydin Serdar, Aydin Hakan, Yorgancioglu Cem, Süzer Kaya, Zorlutuna Yaman
Department of Thoracic and Cardiovascular Surgery, Bayindil Hastanesi Ankara, Kizilirmak mah.28.sok., No: 2 Söğütözü, Ankara, Turkey.
J Card Surg. 2003 Nov-Dec;18(6):524-9; discussion 530-1. doi: 10.1046/j.0886-0440.2003.02063.x.
In trying to answer the question about the controversial use of sequential grafts, we determined the mid-term angiographic outcome of patients in whom coronary artery bypass was performed with different types of vein grafts.
A total of 1034 coronary anastomoses on 724 saphenous vein grafts (SVGs) (apart from 497 left internal mammarian artery (LIMA) anastomoses) were assessed in 509 patients in an average of 55.4 +/- 17.6 months after coronary artery bypass grafting.
The patency rates of sequential conduits were markedly higher than those of individual ones (86.6% vs 69.6%, p = 0.0001). Also, the anastomoses on the sequential conduits had better patency rates (80.6% vs 69.6%, p = 0.0001). This difference was even more pronounced in coronary arteries of poor quality/small (< 1.5 mm) diameter (68.9% vs 51.6%) for the sequential and individual grafts, respectively (p = 0.03). Also, the patency of the entire sequential conduit was lower when most distally located anastomosis was of poor runoff (45.2%).
The patency of a sequential vein conduit is generally superior than that of an individual one, especially for poor runoff coronary vessels, provided that the most distally located anastomosis is performed on a good coronary artery in terms of quality and diameter. Using a minimal length of SVG is another advantage. However, failure of a single sequential conduit jeopardizes all of the anastomoses along that graft segment. Besides, being technically more demanding, technical expertise in performing a sequential anastomosis is probably among the important predictors of patency.
为了回答关于序贯移植争议性使用的问题，我们确定了接受不同类型静脉移植进行冠状动脉搭桥患者的中期血管造影结果。
在509例患者中，平均在冠状动脉搭桥术后55.4±17.6个月时，对724条大隐静脉移植血管（SVG）上的1034处冠状动脉吻合口（不包括497处左乳内动脉（LIMA）吻合口）进行了评估。
序贯血管桥的通畅率显著高于单个血管桥（86.6%对69.6%，p = 0.0001）。此外，序贯血管桥上的吻合口通畅率更高（80.6%对69.6%，p = 0.0001）。这种差异在质量差/直径小（<1.5 mm）的冠状动脉中更为明显，序贯移植和单个移植的通畅率分别为68.9%和51.6%（p = 0.03）。而且，当最远端的吻合口血流不佳时，整个序贯血管桥的通畅率较低（45.2%）。
序贯静脉血管桥的通畅率通常优于单个血管桥，特别是对于血流不佳的冠状动脉血管，前提是最远端的吻合口是在质量和直径方面良好的冠状动脉上进行。使用最短长度的SVG是另一个优点。然而，单个序贯血管桥的失败会危及该移植段上的所有吻合口。此外，由于技术要求更高，进行序贯吻合的技术专长可能是通畅率的重要预测因素之一。
