桡动脉在冠状动脉搭桥手术全动脉化心肌血运重建中的作用。
Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery.
作者信息
Chen Xu-jun, Zhang Yong, Chen Xin, Feng Wen-hui, Li Da-lian, Li Hong-wei
机构信息
Department of Cardiac Surgery, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
出版信息
Chin Med J (Engl). 2008 Feb 5;121(3):200-4.
BACKGROUND
Total arterial revascularization (TAR) was widely utilized in coronary artery bypass grafting (CABG) as a result of its better long-term effect compared with vein grafts. Of the arterial conduits, radial artery (RA) gained popularity for its easy availability and reported long-term patency. Thus, the objective of this study was to investigate the effect of RA in TAR in CABG.
METHODS
From January 2000 to December 2006, 85 patients (56 male and 29 female) at a mean age of 57.0 +/- 5.2 years, underwent TAR in CABG. RA and left internal mammary artery (LIMA) with composite Y or T and sequential grafting techniques were used. Post-operative complications were recorded and follow-up was performed.
RESULTS
Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected. A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA, with the mean number of distal anastomosis per patient of 2.81 +/- 0.47. The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9, Y or T graft off RA in 9. The distal end was anastomsed to right coronary artery system in 92, to obtuse margina in 46, to diagonal in 19 and to ramous intermedius in 5. Nine sequential anastomoses were performed with RA. Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA. One (1.2%) patient died, 3 patients (3.5%) experienced acute renal failure and 2 (2.4%) developed stroke. All patients were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean follow-up of 36.5 +/- 4.1 months (6 - 67 months). Postoperatively at 6 month, mean left ventricular ejective fraction was increased to 0.49 +/- 0.09, compared with that of 0.43 +/- 0.11 preoperatively (P = 0.027). Postoperative mean New York Heart Association class was 2.5 +/- 0.5, compared with that of 3.0 +/- 0.4 preoperatively (P = 0.003).
CONCLUSIONS
TAR with arterial conduits of which RA was mainly used was proved in this study to be effective and safe in CABG.
背景
全动脉血管重建术（TAR）因其与静脉移植物相比具有更好的长期效果，在冠状动脉旁路移植术（CABG）中得到广泛应用。在动脉管道中，桡动脉（RA）因其易于获取和报道的长期通畅性而受到欢迎。因此，本研究的目的是探讨RA在CABG的TAR中的作用。
方法
从2000年1月至2006年12月，85例患者（56例男性和29例女性），平均年龄57.0±5.2岁，接受了CABG中的TAR。使用RA和左乳内动脉（LIMA）采用复合Y或T型以及序贯移植技术。记录术后并发症并进行随访。
结果
共采集了85根LIMA和149根RA移植物，其中包括21根单根RA和64根双侧RA。LIMA共进行了87次远端吻合，RA进行了另外152次，每位患者远端吻合的平均次数为2.81±0.47。140根移植物的RA近端直接与主动脉吻合，9根原位LIMA采用Y或T型分支，9根RA采用Y或T型分支。远端与右冠状动脉系统吻合92次，与钝缘支吻合46次，与对角支吻合19次，与中间支吻合5次。RA进行了9次序贯吻合。用RA和LIMA构建了9个复合Y或T型移植物，另外用RA和RA构建了9个。1例（1.2%）患者死亡，3例（3.5%）患者发生急性肾衰竭，2例（2.4%）发生中风。平均随访36.5±4.1个月（6 - 67个月）后，所有患者均存活，无患者有新发心肌梗死或心绞痛的证据。术后6个月时，平均左心室射血分数升至0.49±0.09，术前为0.43±0.11（P = 0.027）。术后纽约心脏协会平均分级为2.5±0.5，术前为3.0±0.4（P = 0.003）。
结论
本研究证明，主要使用RA作为动脉管道的TAR在CABG中是有效且安全的。
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