Kang Chang Hyun, Kim Ki-Bong, Park Chun Soo, Paeng Jin Chul, Lee Dong Soo
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Ann Thorac Surg. 2005 Jan;79(1):93-8. doi: 10.1016/j.athoracsur.2004.06.056.
There is a concern that revascularization using bilateral internal thoracic arteries (ITA) as a composite graft may not supply sufficient blood flow to a wider area of myocardium when compared with grafting using bilateral in situ ITAs.
One-hundred three patients who underwent off-pump coronary artery bypass using bilateral ITAs for revascularization of the left coronary system were studied prospectively. Bilateral ITAs were used as in situ grafts in 49 patients (group 1) and as a Y-composite graft in 54 patients (group 2). Resting and stress myocardial single-photon emission computed tomography (SPECT) was performed preoperatively and 3 months postoperatively. Myocardial perfusion was automatically quantified and expressed as a percentage of the maximal uptake. The left coronary territory was divided into 16 segments. A total of 379 segments (154 segments in group 1; 225 segments in group 2) that indicated decreased stress perfusion preoperatively were included in this study.
Resting myocardial perfusion revealed no significant differences with regard to both the preoperative (77.5 +/- 9.3% vs 78.8 +/- 8.8%) and postoperative SPECT (78.3 +/- 10.0% vs 77.2 +/- 10.5%) between groups 1 and 2 (p = not significant [NS]). However, stress myocardial perfusion was significantly lower in group 1 preoperatively (62.5 +/- 10.8% vs 65.4 +/- 10.1%, p < 0.01). Although it improved postoperatively, there were no differences regarding postoperative stress myocardial perfusion between the two groups (75.5 +/- 11.3% vs 75.0 +/- 11.7%; p = NS). The degree of improvement regarding stress myocardial perfusion (difference between the preoperative and postoperative values) was higher in group 1 than in group 2 (13.0 +/- 9.4% vs 9.6 +/- 10.0%, p < 0.005).
Myocardial SPECT demonstrated that revascularization using bilateral in situ ITAs exhibited a greater level of improvement with regard to stress perfusion postoperatively compared with Y-composite grafts. However, because there was no considerable difference with regard to postoperative stress perfusion between the two groups, revascularization using a Y-composite graft might also be sufficient for revascularization of the left coronary territory.
有人担心，与使用双侧原位胸廓内动脉（ITA）进行移植相比，使用双侧ITA作为复合移植物进行血管重建可能无法为更广泛的心肌区域提供足够的血流。
对103例行非体外循环冠状动脉搭桥术、使用双侧ITA对左冠状动脉系统进行血管重建的患者进行前瞻性研究。49例患者（第1组）使用双侧ITA作为原位移植物，54例患者（第2组）使用双侧ITA作为Y形复合移植物。术前及术后3个月进行静息和负荷心肌单光子发射计算机断层扫描（SPECT）。自动定量心肌灌注，并表示为最大摄取量的百分比。左冠状动脉区域分为16个节段。本研究纳入了术前显示负荷灌注降低的379个节段（第1组154个节段；第2组225个节段）。
第1组和第2组在术前（77.5±9.3%对78.8±8.8%）和术后SPECT（78.3±10.0%对77.2±10.5%）的静息心肌灌注方面均无显著差异（p=无显著差异[NS]）。然而，第1组术前的负荷心肌灌注显著较低（62.5±10.8%对65.4±10.1%，p<0.01）。虽然术后有所改善，但两组术后负荷心肌灌注无差异（75.5±11.3%对75.0±11.7%；p=NS）。第1组负荷心肌灌注的改善程度（术前和术后值之间的差异）高于第2组（13.0±9.4%对9.6±10.0%，p<0.005）。
心肌SPECT显示，与Y形复合移植物相比，使用双侧原位ITA进行血管重建术后在负荷灌注方面的改善程度更大。然而，由于两组术后负荷灌注无显著差异，使用Y形复合移植物进行血管重建可能也足以对左冠状动脉区域进行血管重建。
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