Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):256-62. doi: 10.1016/j.jtcvs.2009.08.040.
We performed early postoperative angiography to assess anastomosis accuracy and patency after off-pump coronary artery bypass grafting.
One thousand three hundred forty-five patients who underwent off-pump coronary artery bypass grafting between January 1998 and December 2007 were studied. Grafts for distal anastomoses were left internal thoracic artery (n=1281), right internal thoracic artery (n=679), right gastroepiploic artery (n=836), radial artery (n=14), and saphenous vein (n=188). Groups underwent off-pump coronary artery bypass grafting without (group I, n=234) or with (group II, n=1111) intraoperative graft flowmetry. Early postoperative (< or = 7 days) angiography was performed in 1278 cases (95.0%) at 1.6+/-1.2 postoperative days.
Operative mortality was 1.6%. Average number of distal anastomoses was 3.0+/-1.0. Postoperative angiography showed early patencies of 98.9% for arterial grafts and 88.2% for venous grafts (P < .001). In group II, intraoperative flowmetry-guided revision was performed in 2.2% of distal anastomoses. Patency of arterial grafts was significantly higher in group II than group I (97.2% vs 99.1%, P < .001); however, patency of venous grafts was not significantly different (86.0% vs 92.2%, P=.099). Early reoperation for graft revision according to angiographic findings was performed in 35 patients.
Early patency of venous grafts was significantly lower than that of arterial grafts. Intraoperative flowmetry and revision of abnormal grafts improved early graft patency, and reoperation according to early angiographic findings may further improve graft patency.
我们进行早期术后血管造影术，以评估非体外循环冠状动脉旁路移植术后吻合口的准确性和通畅性。
1998 年 1 月至 2007 年 12 月期间，我们对 1345 例接受非体外循环冠状动脉旁路移植术的患者进行了研究。远端吻合的移植物为左内乳动脉（n=1281）、右内乳动脉（n=679）、右胃网膜动脉（n=836）、桡动脉（n=14）和大隐静脉（n=188）。两组患者分别接受了非体外循环冠状动脉旁路移植术（无术中移植物流量测定组，I 组，n=234；有术中移植物流量测定组，II 组，n=1111）。1278 例患者（95.0%）在术后 1.6+/-1.2 天进行了早期术后（<=7 天）血管造影检查。
手术死亡率为 1.6%。平均吻合口数量为 3.0+/-1.0。术后血管造影显示动脉移植物的早期通畅率为 98.9%，静脉移植物的早期通畅率为 88.2%（P<.001）。在 II 组中，有 2.2%的远端吻合口进行了术中流量测量指导下的修正。与 I 组相比，II 组动脉移植物的通畅率明显更高（97.2% vs 99.1%，P<.001）；然而，静脉移植物的通畅率没有明显差异（86.0% vs 92.2%，P=.099）。根据血管造影结果，有 35 例患者进行了早期再手术进行移植修正。
静脉移植物的早期通畅率明显低于动脉移植物。术中流量测量和异常移植物的修正改善了早期移植物的通畅率，根据早期血管造影结果进行的再次手术可能进一步提高移植物的通畅率。
