Carneiro F, Mota J C, Miranda J, Ponce P, Vieira M, Guerreiro M, Vouga L
Serviço de Cirurgia Cardio-Torácica Centro Hospitalar de Vila Nova de Gaia, Portugal.
Rev Port Cir Cardiotorac Vasc. 2003 Apr-Jun;10(2):49-54.
Among several other factors, in coronary surgery the results depend on the quality and durability of the grafts. Revascularization employing arterial conduits, namely the radial artery, has been playing a growing role, with the aim of replacing the autologous saphenous vein. The benefits and risks of this strategy is still a matter of controversy. The goal of the present study was the evaluation of the incidence of early complications related to the use of radial artery in the revascularization surgery of the myocardium.
A series of consecutive patients who underwent coronary revascularization surgery in the CHVNGaia using radial artery, from January 2000 to December 2001, was retrospectively analyzed. Data were obtained through the revision of the clinical charts and hospital database. The major end-point assessed was the 30-day or intra hospital postoperative death; furthermore, acute myocardial infarction, stroke, renal failure, prolonged ventilation and reoperations for acute graft occlusion, bleeding and mediastistinitis were also evaluated.
During that period of time, 656 patients underwent coronary revascularization surgery, but the radial artery was used in only 230 (35%). Mean age was 60.2+/- 9.1 years and 42 (18.3%) were female. Two hundred and four patients (88.6%) were operated on under extracorporeal circulation. The average number of grafts was 2.6+/- 0.6 per patient. Mean duration of orotraqueal intubation was 2.4 +/- 6 hours. Thirty patients (14,3 %) developed atrial fibrillation and ten (4.3%) had postoperative bleeding. Perioperative myocardial infarction occurred in five cases (2.2%). Two patients (0.8%) underwent reoperation for mediastinitis and one patient (0.4%) was reoperated on for acute occlusion of the graft. The overall postoperative mortality was 1.3% (3 patients).
The use of radial artery in coronary revascularization did not caused morbidity and mortality, out of the usual context of coronary surgery. The results of our experience suggest that radial artery can be successfully used in myocardial revascularization surgery, enlarging the possibilities of utilization of arterial autografts.
在冠状动脉手术中，结果取决于多种因素，其中移植物的质量和耐用性至关重要。采用动脉管道（即桡动脉）进行血运重建发挥着越来越重要的作用，旨在替代自体大隐静脉。该策略的益处和风险仍存在争议。本研究的目的是评估在心肌血运重建手术中使用桡动脉相关的早期并发症发生率。
回顾性分析了2000年1月至2001年12月期间在CHVNGaia接受使用桡动脉的冠状动脉血运重建手术的一系列连续患者。通过查阅临床病历和医院数据库获取数据。评估的主要终点是术后30天或住院期间死亡；此外，还评估了急性心肌梗死、中风、肾衰竭、通气时间延长以及因急性移植物闭塞、出血和纵隔炎进行的再次手术。
在此期间，656例患者接受了冠状动脉血运重建手术，但仅230例（35%）使用了桡动脉。平均年龄为60.2±9.1岁，女性42例（18.3%）。204例患者（88.6%）在体外循环下进行手术。每位患者平均移植血管数为2.6±0.6根。口气管插管平均持续时间为2.4±6小时。30例患者（14.3%）发生房颤，10例（4.3%）术后出血。围手术期心肌梗死发生5例（2.2%）。2例患者（0.8%）因纵隔炎接受再次手术，1例患者（0.4%）因移植物急性闭塞接受再次手术。总体术后死亡率为1.3%（3例患者）。
在冠状动脉手术的常规情况下，冠状动脉血运重建中使用桡动脉并未导致发病率和死亡率升高。我们的经验结果表明，桡动脉可成功用于心肌血运重建手术，扩大了自体动脉移植物的使用可能性。
