Suma H, Wanibuchi Y, Furuta S, Takeuchi A
Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
J Thorac Cardiovasc Surg. 1991 Jan;101(1):121-5.
Seventy patients in whom the gastroepiploic artery was used for coronary artery bypass grafting were compared with 70 patients in whom the gastroepiploic artery was not used. Mean age was 56.8 years in the group in which this artery was used and 61.8 years in the group in which it was not (p less than 0.001). All other preoperative characteristics including number of women, extent of coronary artery disease, previous myocardial infarction, unstable angina, and preoperative left ventricular function were not significantly different between the two groups. An internal mammary artery graft was concomitantly used in 68 patients (97%) of the group with a gastroepiploic artery graft and in 61 patients (87%) without such a graft. The mean number of distal anastomoses was 3.3 and 3.4, aortic crossclamp time was 65.3 +/- 19.9 minutes and 54.0 +/- 20.1 minutes, and cardiopulmonary bypass time was 114.8 +/- 23.6 minutes and 112.9 +/- 25.0 minutes, respectively, in the groups with and without a gastroepiploic artery graft. Only aortic crossclamp time was significantly (p less than 0.05) longer in the group with a gastroepiploic artery graft. There were two (2.9%) early deaths and two (2.9%) new Q-wave infarctions in both groups. Intraaortic balloon pumping was required in five patients (7.1%) in the group with a gastroepiploic artery graft and in three patients (4.3%) without this graft. Postoperative complications were similar and rare in both groups. Intraoperative endoscopic laser Doppler study demonstrated no significant change of gastric mucosal blood flow before and after division of the gastroepiploic artery. We concluded that there is no additional risk in the use of the gastroepiploic artery for coronary bypass grafting, and a favorable outcome can be expected.
将70例使用胃网膜动脉进行冠状动脉旁路移植术的患者与70例未使用胃网膜动脉的患者进行了比较。使用该动脉的组平均年龄为56.8岁，未使用该动脉的组平均年龄为61.8岁（p<0.001）。两组之间所有其他术前特征，包括女性数量、冠状动脉疾病程度、既往心肌梗死、不稳定型心绞痛和术前左心室功能，均无显著差异。使用胃网膜动脉移植的组中有68例患者（97%）同时使用了乳内动脉移植，未使用胃网膜动脉移植的组中有61例患者（87%）同时使用了乳内动脉移植。使用胃网膜动脉移植和未使用胃网膜动脉移植的组中，远端吻合的平均数量分别为3.3和3.4，主动脉阻断时间分别为65.3±19.9分钟和54.0±20.1分钟，体外循环时间分别为114.8±23.6分钟和112.9±25.0分钟。只有使用胃网膜动脉移植的组主动脉阻断时间显著更长（p<0.05）。两组均有2例（2.9%）早期死亡和2例（2.9%）新发Q波梗死。使用胃网膜动脉移植的组中有5例患者（7.1%）需要进行主动脉内球囊反搏，未使用该移植的组中有3例患者（4.3%）需要进行主动脉内球囊反搏。两组术后并发症相似且少见。术中内镜激光多普勒研究显示，胃网膜动脉离断前后胃黏膜血流无显著变化。我们得出结论，使用胃网膜动脉进行冠状动脉旁路移植术没有额外风险，并且可以预期获得良好的结果。
