Hirai S, Hamanaka Y, Mitsui N, Morifuji K, Sutoh M
Department of Thoracic and Cardiovascular Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Kyobu Geka. 2005 Aug;58(9):795-8.
This study was designed to evaluate proximal native coronary stenosis (PNCS) after coronary artery bypass grafting (CABG). In 36 patients undergoing postoperative coronary arteriography, the PNCS bypassed with internal thoracic artery (ITA), saphenous vein graft (SVG) and right gastroepiploic artery (RGEA) progressed in 9 of 23 vessels (39%), in 15 of 28 vessels (53%), in 4 of 11 vessels (36%), respectively. Stenosis of no grafted coronary vessels progressed in 3 of 26 vessels (11%). Twelve native coronary vessels (9: 99% and 3: 90% stenosis vessels) bypassed with grafts were obstructed. This study confirms that the PNCS progresses significantly by CABG just after the operation and that it tends to progress highly with SVG in comparison with arterial grafts such as ITA or RGEA. Because operative mortality for repeated CABG is approximately twice as high as that for primary CABG, it is important to decide whether early postoperative percutaneous transluminal angioplasty is needed or not, in considering of future graft failure and stenosis progression of the native coronary vessels by CABG.
本研究旨在评估冠状动脉旁路移植术（CABG）后近端自身冠状动脉狭窄（PNCS）情况。在36例行术后冠状动脉造影的患者中，采用胸廓内动脉（ITA）、大隐静脉移植血管（SVG）和右胃网膜动脉（RGEA）搭桥的PNCS，在23支血管中有9支（39%）出现进展，28支血管中有15支（53%）出现进展，11支血管中有4支（36%）出现进展。未搭桥的冠状动脉血管狭窄在26支血管中有3支（11%）出现进展。12支接受移植血管搭桥的自身冠状动脉血管（9支：99%狭窄血管和3支：90%狭窄血管）发生阻塞。本研究证实，术后早期CABG可使PNCS显著进展，与ITA或RGEA等动脉移植血管相比，SVG搭桥的PNCS更易出现高度进展。由于再次CABG的手术死亡率约为初次CABG的两倍，因此在考虑未来移植血管失败及CABG导致的自身冠状动脉血管狭窄进展时，决定是否需要术后早期经皮腔内血管成形术很重要。
