Pevni Dmitry, Hertz Itzhak, Medalion Benjamin, Kramer Amir, Paz Yosef, Uretzky Gideon, Mohr Rephael
Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Thorac Cardiovasc Surg. 2007 May;133(5):1220-5. doi: 10.1016/j.jtcvs.2006.07.060.
Composite arterial grafting causes splitting of internal thoracic artery flow to various myocardial regions. The amount of flow supplying each region depends on the severity of coronary stenosis. Competitive flow in the native coronary artery can cause occlusion or severe narrowing of the internal thoracic artery supplying this coronary vessel.
Two hundred three consecutive postoperative coronary angiographies of 163 patients who underwent bilateral internal thoracic artery grafting using the composite-T-graft technique were analyzed. Angiographies were done in symptomatic patients or in patients with positive thallium scan between 2 and 102 months after surgery and were compared with preoperative angiograms.
In 123 patients, both internal thoracic arteries were patent. The remaining 40 control patients had at least 1 nonfunctioning internal thoracic artery. A lower stenosis rate in the left anterior and circumflex arteries was associated with higher occlusion rate of the left internal thoracic artery (P < .005) and the right internal thoracic artery (P < .005), respectively. In 19 angiograms of 18 patients, graft failure could be related to competitive flow. This included 7 patients with disease of the left main artery and a preoperative stenosis degree ranging between 50% and 80%, 8 patients with moderate stenosis (70% or less) of the circumflex artery, and 3 with moderate stenosis of the left anterior descending artery. Three of the patients with disease of the left main artery, 2 of the patients with competitive flow in the circumflex artery, and all patients in the subgroup with left anterior descending arterial disease underwent percutaneous or surgical reintervention.
The composite T-graft technique of bilateral internal thoracic artery grafting should be reserved for patients with severe (70% or more) left anterior descending and circumflex arterial stenosis.
复合动脉移植会导致胸廓内动脉血流分流至不同的心肌区域。供应每个区域的血流量取决于冠状动脉狭窄的严重程度。自身冠状动脉中的竞争性血流可导致供应该冠状动脉的胸廓内动脉闭塞或严重狭窄。
分析了163例行双侧胸廓内动脉移植复合T形移植技术患者的203例连续术后冠状动脉造影。在有症状的患者或术后2至102个月铊扫描阳性的患者中进行造影，并与术前造影进行比较。
123例患者的双侧胸廓内动脉均通畅。其余40例对照患者至少有1条胸廓内动脉无功能。左前降支和回旋支动脉较低的狭窄率分别与左胸廓内动脉（P <.005）和右胸廓内动脉（P <.005）较高的闭塞率相关。在18例患者的19次造影中，移植失败可能与竞争性血流有关。这包括7例左主干动脉疾病且术前狭窄程度在50%至80%之间的患者、8例回旋支动脉中度狭窄（70%或更低）的患者以及3例左前降支动脉中度狭窄的患者。3例左主干动脉疾病患者、2例回旋支动脉有竞争性血流的患者以及左前降支动脉疾病亚组的所有患者均接受了经皮或手术再干预。
双侧胸廓内动脉移植的复合T形移植技术应仅用于左前降支和回旋支动脉严重狭窄（70%或更高）的患者。
