胃网膜动脉移植用于冠状动脉旁路移植术的二十年经验。

Twenty years experience with the gastroepiploic artery graft for CABG.

作者信息

Suma Hisayoshi, Tanabe Hiroaki, Takahashi Akihito, Horii Taiko, Isomura Tadashi, Hirose Hitoshi, Amano Atsushi

机构信息

The Cardiovascular Institute, 7-3-10 Roppongi, Minato-Ku, Tokyo 106-0032, Japan.

出版信息

Circulation. 2007 Sep 11;116(11 Suppl):I188-91. doi: 10.1161/CIRCULATIONAHA.106.678813.

DOI:10.1161/CIRCULATIONAHA.106.678813

PMID:17846302

Abstract

BACKGROUND

To improve the longterm outcome after CABG, several strategies have been used using arterial conduits. Our 20 years experience with the right gastroepiploic artery (GEA) graft was evaluated.

METHODS AND RESULTS

In 1352 patients having CABG with the GEA graft, (1092 men, mean 63 years, 99% multivessel disease, and mean EF 0.51), internal thoracic artery, saphenous vein, and radial artery grafts were concomitantly used in 1312 (97%), 783 (58%), and 128 (8%) patients, respectively. The mean number of distal anastomoses was 3.1, and 2.4 coronary arteries were bypassed with arterial grafts. The sites for GEA grafting were 70 anterior descending, 268 circumflex, and 1089 right coronary arteries. The operative mortality was 1.26%. In 1118 follow-up patients (82.6%), 5, 10, and 15 years survival rates were 91.7%, 81.4%, and 71.3%, and the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 97.1% at 1 month, 92.3% at 1 year, 85.5% at 5 years, and 66.5% at 10 years, respectively. In 172 skeletonized GEA grafts with 233 distal anastomoses, the patency rate at immediate, 1, and 4 years after surgery was 97.6%, 92.9%, and 86.4%, respectively. In 124 patients with late (5 to 17 years) restudy, patency rate was 96% (114/119) in the left internal thoracic artery, 87% (108/124) in GEA, and 68% (67/98) in saphenous vein grafts. New stenosis was uncommon in GEA.

CONCLUSION

The GEA graft is a safe and effective arterial conduit for CABG.

摘要

背景

为改善冠状动脉旁路移植术（CABG）后的长期疗效，已采用多种使用动脉移植物的策略。我们评估了20年来使用右胃网膜动脉（GEA）移植物的经验。

方法与结果

在1352例行CABG并使用GEA移植物的患者中（1092例男性，平均63岁，99%为多支血管病变，平均射血分数0.51），分别有1312例（97%）、783例（58%）和128例（8%）患者同时使用了胸廓内动脉、大隐静脉和桡动脉移植物。远端吻合的平均数量为3.1个，2.4支冠状动脉通过动脉移植物进行搭桥。GEA移植物的植入部位为70支前降支、268支回旋支和1089支右冠状动脉。手术死亡率为1.26%。在1118例接受随访的患者（82.6%）中，5年、10年和15年的生存率分别为91.7%、81.4%和71.3%，无心脏死亡生存率分别为95.8%、91.7%和88.6%。GEA移植物的累积通畅率在1个月时为97.1%，1年时为92.3%，5年时为85.5%，10年时为66.5%。在172例进行骨骼化处理的GEA移植物（共233个远端吻合）中，术后即刻、1年和4年的通畅率分别为97.6%、92.9%和86.4%。在124例进行晚期（5至17年）复查研究的患者中，胸廓内动脉的通畅率为96%（114/119），GEA为87%（108/124），大隐静脉移植物为68%（67/98）。GEA中新发狭窄并不常见。