Cho Kwang Ree, Kim Jun-Sung, Choi Jae-Sung, Kim Ki-Bong
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28 Yeon-Gun Dong, Jong-Ro Gu, Seoul 110-744, South Korea.
Eur J Cardiothorac Surg. 2006 Apr;29(4):511-6. doi: 10.1016/j.ejcts.2005.12.026. Epub 2006 Jan 24.
We studied retrospectively the patency of grafts after coronary artery bypass grafting (CABG) using serial angiographies performed one year and five years after surgery.
One hundred and nine patients who had available coronary angiographies at both one year and five years after CABG were included. Morphologic changes of anastomotic sites and grafts were traced in the same group of patients using the FitzGibbon grading system.
The arterial graft patency rate (FitzGibbon grade A+B) was significantly higher than the saphenous vein grafts at both one year (98.0% vs 82.4%, p<0.001) and five years (90.7% vs 80.2%, p=0.006) after surgery, respectively. The arterial graft patency rate was superior to vein grafts in the left anterior descending coronary artery territory at both one year (97.5% vs 82.0%, p=0.001) and five years (90.9% vs 78.0%, p=0.042) postoperatively. Other territories showed similar patency rates between arterial and vein grafts. The vein graft patency rate at five years postoperatively was lowest in the right coronary territory when compared with other territories. When the patency pattern was compared between postoperative years 1 and 5, the proportion of FitzGibbon grade B grafts increased significantly in the vein grafts (3.1% vs 7.5%, p=0.002), while that of arterial grafts remained stable (8.6% vs 7.3%, p=0.774). When the graft patency at postoperative year 5 was compared between patients with recurrent angina and those without, the patients with recurrent angina showed a higher proportion of FitzGibbon grade B grafts (19.2% vs 4.8% in arterial grafts, p=0.023; 20.5% vs 4.8% in vein grafts, p=0.003) and lower grade A grafts (65.4% vs 86.4% in arterial grafts, p=0.019; 43.6% vs 78.2% in vein grafts, p<0.001), and a lower vein graft patency rate (64.1% vs 83.0%, p=0.014).
The arterial graft patency rate was significantly higher than that of saphenous vein grafts, especially in the left anterior descending coronary artery territory, at one year and five years postoperatively. The decreased patency rate of the vein grafts, along with insulin-dependent diabetes mellitus, were associated with angina recurrence.
我们通过对冠状动脉旁路移植术（CABG）术后1年和5年进行的系列血管造影术，回顾性研究了移植血管的通畅情况。
纳入109例在CABG术后1年和5年均有可用冠状动脉造影的患者。使用菲茨吉本分级系统追踪同一组患者吻合口部位和移植血管的形态学变化。
术后1年（98.0%对82.4%，p<0.001）和5年（90.7%对80.2%，p=0.006）时，动脉移植血管通畅率（菲茨吉本分级A+B）均显著高于大隐静脉移植血管。术后1年（97.5%对82.0%，p=0.001）和5年（90.9%对78.0%，p=0.042）时，在左前降支冠状动脉区域，动脉移植血管通畅率优于静脉移植血管。其他区域动脉和静脉移植血管的通畅率相似。与其他区域相比，术后5年右冠状动脉区域的静脉移植血管通畅率最低。当比较术后第1年和第5年的通畅模式时，静脉移植血管中菲茨吉本分级B的移植血管比例显著增加（3.1%对7.5%，p=0.002），而动脉移植血管的比例保持稳定（8.6%对7.3%，p=0.774）。当比较术后第5年有复发性心绞痛患者和无复发性心绞痛患者的移植血管通畅情况时，有复发性心绞痛的患者中菲茨吉本分级B的移植血管比例更高（动脉移植血管中为19.2%对4.8%，p=0.023；静脉移植血管中为20.5%对4.8%，p=0.003），分级A的移植血管比例更低（动脉移植血管中为65.4%对86.4%，p=0.019；静脉移植血管中为43.6%对78.2%，p<0.001），且静脉移植血管通畅率更低（64.1%对83.0%，p=0.014）。
术后1年和5年时，动脉移植血管通畅率显著高于大隐静脉移植血管，尤其是在左前降支冠状动脉区域。静脉移植血管通畅率下降以及胰岛素依赖型糖尿病与心绞痛复发有关。
