Chowdhry T M F, Loubani Mahmoud, Galiñanes Manuel
Division of Cardiac Surgery, Department of Surgery, Glenfield Hospital, Leicester, UK.
J Card Surg. 2005 Nov-Dec;20(6):530-6. doi: 10.1111/j.1540-8191.2005.00155.x.
The aim of this study is to evaluate the mid-results of the use of the radial artery alongside the internal mammary artery for complete arterial revascularization in elective and nonelective coronary bypass graft surgery.
All patients undergoing coronary artery surgery alone over a 3-year period with disease of more than one coronary artery were considered for complete arterial revascularization. Preoperatively, all patients had an Allen's test on the dominant arm and a cutoff point of 10 seconds was used. These patients were initially followed in the outpatient clinic after 6 weeks and then further followed up with the help of a mailed questionnaire. The incidence of recurrent angina and reangiogram was obtained and selected patients were further interviewed and examined in the outpatient department.
Over a 3-year period, 291 patients underwent total arterial revascularization using the radial and internal mammary arteries alone in Y-graft configuration. The mean age of the study population was 62.4 +/- 8.8 years, with a male to female ratio of 221 to 70. Elective surgery was performed in 230 patients (79.4%), with nonelective procedures comprising a total of 61 patients (20.6%). The mean number of distal anastomoses was 2.9 +/- 0.9. There were four perioperative mortalities (1.37%) and 43 patients (14.7%) developed low cardiac output syndrome, requiring inotropes with or without intra-aortic balloon pump. Forty patients (13.7%) developed postoperative supraventricular arrhythmias. There was no incidence of hand ischemia or wound complications. After a mean follow-up period of 35.4 +/- 6.3 months of 220 patients (75%), there was one further death and 24 patients required readmissions for cardiac-related causes. Ten patients had reangiogram for angina of which one patient had a blocked radial artery graft and two patients underwent angioplasty to their native coronary arteries. The patients' angina score was currently 0.5 +/- 1.0 versus 2.6 +/- 1.4 preoperatively.
Total arterial revascularization with the internal mammary and radial artery is associated with a low rate of perioperative complications and mortality and can be safely used in both elective and nonelective bypass graft surgery with excellent clinical results.
本研究旨在评估在择期和非择期冠状动脉搭桥手术中，使用桡动脉联合乳内动脉进行完全动脉血运重建的中期结果。
在3年期间，所有仅接受冠状动脉手术且患有多支冠状动脉疾病的患者均考虑进行完全动脉血运重建。术前，对优势手臂进行所有患者的艾伦试验，采用10秒的截断点。这些患者最初在6周后在门诊随访，然后通过邮寄问卷进行进一步随访。获取复发性心绞痛和再次血管造影的发生率，并对选定患者在门诊进行进一步访谈和检查。
在3年期间，291例患者仅使用桡动脉和乳内动脉以Y形移植配置进行了完全动脉血运重建。研究人群平均年龄为62.4±8.8岁，男女比例为221比70。230例患者（79.4%）进行了择期手术，非择期手术共61例患者（20.6%）。远端吻合的平均数量为2.9±0.9。围手术期有4例死亡（1.37%），43例患者（14.7%）发生低心排血量综合征，需要使用或不使用主动脉内球囊泵的血管活性药物。40例患者（13.7%）发生术后室上性心律失常。未发生手部缺血或伤口并发症。在220例患者（75%）平均随访35.4±6.3个月后，又有1例死亡，24例患者因心脏相关原因再次入院。10例患者因心绞痛进行了再次血管造影，其中1例患者桡动脉移植血管堵塞，2例患者对自身冠状动脉进行了血管成形术。患者目前的心绞痛评分为0.5±1.0，而术前为2.6±1.4。
使用乳内动脉和桡动脉进行完全动脉血运重建与围手术期并发症和死亡率较低相关，可安全用于择期和非择期搭桥手术，临床效果良好。
