Department of Cardiovascular Surgery, Hôpital Georges Pompidou, Paris, France.
J Thorac Cardiovasc Surg. 2010 Jul;140(1):73-9, 79.e1-2. doi: 10.1016/j.jtcvs.2009.09.032. Epub 2009 Nov 26.
The aim of this study was to assess the angiographic results of the radial artery as a coronary bypass conduit at long term (>5 years).
Radial artery grafts were controlled in 202 patients at 10.1 years by conventional angiography (n = 79) and computed tomography (n = 123). Clinical or paraclinical evidence of ischemia was noted in 81 patients, whereas 121 patients were asymptomatic. Some 520 conduits were controlled: radial artery (n = 230), left internal thoracic artery (n = 190), right internal thoracic artery (n = 30), and veins (n = 70). Radial arteries were anastomosed to the right coronary (24%), marginal (58%), diagonal (16%), and left anterior descending (<1%) arteries, whereas left internal thoracic arteries were primarily anastomosed to the left anterior descending artery (95%). The mean number of antithrombotic and anti-anginal medications was 1.2 and 1.9 per patient, respectively.
The ejection fraction was slightly decreased compared with its preoperative value (54% +/- 11% vs 57% +/- 9%; P = .009). Nine reoperations were required at 10.5 years for valve replacement (n = 8) and isolated bypass (n = 1). Percutaneous intervention was performed in 48 patients (24%) at 7.6 years on a graft (28%) or a native coronary artery (72%). The 10-year patency of radial artery grafts was 83%, which was lower than the patency of left internal thoracic arteries (95%, P < .001) and similar to the patency of right internal thoracic arteries (87%, P = .66) and veins (81%, P = .50). No medication seemed to influence radial artery graft patency (aspirin: P = .26; calcium blockers: P = .36). All graft patency was lower when clinical or paraclinical evidence of ischemia was present than in asymptomatic cases (83% vs 90% P = .02). The patency of left anterior descending grafts was higher than that of non-left anterior descending grafts (96% vs 82% P < .001).
The radial artery-to-coronary bypass conduit provided a low coronary reoperation rate with an excellent patency (83%) up to 20 years postoperatively.
本研究旨在评估桡动脉作为冠状动脉旁路移植血管的长期（>5 年）血管造影结果。
通过常规血管造影（n=79）和计算机断层扫描（n=123）在 202 例患者中对桡动脉移植物进行了 10.1 年的控制。81 例患者有缺血的临床或辅助临床证据，而 121 例患者无症状。控制了 520 个移植物：桡动脉（n=230）、左内乳动脉（n=190）、右内乳动脉（n=30）和静脉（n=70）。桡动脉与右冠状动脉（24%）、边缘（58%）、对角（16%）和左前降支（<1%）吻合，而左内乳动脉主要与左前降支吻合（95%）。每位患者的抗血栓和抗心绞痛药物平均数量分别为 1.2 和 1.9。
与术前相比，射血分数略有下降（54%±11% vs 57%±9%；P=0.009）。10.5 年时，8 例因瓣膜置换术（n=8）和单纯旁路术（n=1）需进行 9 次再手术。7.6 年时，48 例患者（24%）对移植物（28%）或原生冠状动脉（72%）进行了经皮介入治疗。桡动脉移植物 10 年通畅率为 83%，低于左内乳动脉（95%，P<0.001），与右内乳动脉（87%，P=0.66）和静脉（81%，P=0.50）相似。没有药物似乎影响桡动脉移植物通畅率（阿司匹林：P=0.26；钙通道阻滞剂：P=0.36）。当存在缺血的临床或辅助临床证据时，所有移植物通畅率均低于无症状病例（83%比 90%，P=0.02）。左前降支移植物的通畅率高于非左前降支移植物（96%比 82%，P<0.001）。
桡动脉-冠状动脉旁路移植术提供了较低的冠状动脉再手术率，20 年后其通畅率（83%）极佳。
