Kamiya Hiroyuki, Watanabe Go, Takemura Hirofumi, Tomita Shigeyuki, Nagamine Hiroshi, Kanamori Taro
Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, Takaramachi, Japan.
J Thorac Cardiovasc Surg. 2004 Apr;127(4):1151-7. doi: 10.1016/j.jtcvs.2003.09.057.
Total arterial revascularization in coronary artery bypass grafting has recently become of great interest to many surgeons. At the same time, off-pump coronary bypass grafting has also become a popular procedure because of its low morbidity and mortality. Here we report our recent series of off-pump coronary bypass grafting performed with a grafting technique we developed by using the skeletonized gastroepiploic artery and the radial artery composite graft to achieve total arterial revascularization.
From September 2000 to April 2003, 98 patients underwent total arterial revascularization with the skeletonized gastroepiploic artery and radial artery composite graft on the beating heart. We used the gastroepiploic artery graft of choice in patients with a right coronary artery lesion. When multiple grafting was required in inferior, posterolateral, or lateral ventricular walls and the gastroepiploic artery graft was too short to cover these areas, we used the composite grafting technique.
There were no in-hospital deaths and there was no severe morbidity among the study patients. Postoperative angiography showed graft occlusion at the anastomosis site between the gastroepiploic and radial arteries. The patency rate of the gastroepiploic arterial composite graft was 98.3% (118/120 distal anastomoses).
A composite graft with the skeletonized gastroepiploic artery and the radial artery ensured sufficient caliber size and length for myocardial revascularization on inferior, posterolateral, and lateral ventricular walls. This composite graft can be used safely and effectively even in off-pump coronary bypass surgery with excellent early clinical and angiographic outcome in selected patients, although longer follow-up periods are necessary to draw definitive conclusions.
冠状动脉旁路移植术中全动脉化血运重建近来引起了众多外科医生的极大兴趣。与此同时，非体外循环冠状动脉旁路移植术因其低发病率和死亡率也成为一种常用术式。在此，我们报告近期采用一种我们研发的移植技术进行的非体外循环冠状动脉旁路移植术系列病例，该技术使用骨骼化胃网膜动脉和桡动脉复合移植物以实现全动脉化血运重建。
2000年9月至2003年4月，98例患者在心脏跳动状态下接受了使用骨骼化胃网膜动脉和桡动脉复合移植物的全动脉化血运重建术。对于右冠状动脉病变患者，我们选用胃网膜动脉移植物。当下壁、后外侧壁或侧壁心室壁需要多处移植且胃网膜动脉移植物太短无法覆盖这些区域时，我们采用复合移植技术。
研究患者中无院内死亡病例，也无严重并发症。术后血管造影显示胃网膜动脉与桡动脉吻合部位出现移植物闭塞。胃网膜动脉复合移植物的通畅率为98.3%（120处远端吻合中有118处通畅）。
骨骼化胃网膜动脉和桡动脉的复合移植物确保了足够的管径大小和长度，可用于下壁、后外侧壁和侧壁心室壁的心肌血运重建。即使在非体外循环冠状动脉旁路手术中，这种复合移植物也能安全有效地使用，在选定患者中具有良好的早期临床和血管造影结果，不过需要更长的随访期才能得出确切结论。
