Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Ann Thorac Surg. 2010 Mar;89(3):683-7. doi: 10.1016/j.athoracsur.2009.11.053.
Composite grafting is a useful technique that avoids the need for aortic manipulation and enables a wide range of target vessels to be revascularized, effectively using the limited arterial grafts available. However, it has not been clarified whether composite grafting can achieve angiographic outcomes equivalent to those obtained with individual grafting for specific target vessels.
We retrospectively reviewed 830 distal arterial graft anastomoses in 256 patients who underwent off-pump coronary artery bypass surgery and also underwent 1-year follow-up coronary angiograms. Four hundred and ten anastomoses using a composite grafting technique were compared with 420 anastomoses using individual grafting.
In target vessels with mild stenosis, the incidence of graft occlusion or string sign was significantly higher in composite internal thoracic arteries (ITA) than in individual ITA grafts (composite 20.3% versus individual 7.3%; p = 0.018) and showed a higher tendency in composite radial arteries (RA) than in individual RA grafts (59.3% versus 36.4%, p = 0.09). In contrast, the incidence was similar between composite and individual ITA grafts (5.7% versus 3.3%, p = 0.278) and composite and individual RA grafts (11.5% versus 29.6%, p = 0.297) in target vessels with severe stenosis.
The angiographic outcomes of composite grafts were closely related to the severity of stenosis of the target coronary artery. In target vessels with mild stenosis, composite grafting resulted in a higher incidence of graft occlusion or string sign than individual grafting did.
复合移植是一种有用的技术，它可以避免主动脉操作，并使广泛的靶血管得以再血管化，有效地利用有限的动脉移植物。然而，目前尚不清楚复合移植是否能达到与特定靶血管的单个移植相当的血管造影结果。
我们回顾性分析了 256 例接受非体外循环冠状动脉旁路移植术并进行了 1 年随访冠状动脉造影的患者的 830 个远端动脉移植物吻合口。将 410 个采用复合移植技术的吻合口与 420 个采用单个移植物的吻合口进行比较。
在轻度狭窄的靶血管中，复合内乳动脉（ITA）的吻合口闭塞或串珠征发生率明显高于单个 ITA 移植物（复合 20.3%对单个 7.3%；p = 0.018），且复合桡动脉（RA）的发生率高于单个 RA 移植物（复合 59.3%对单个 36.4%，p = 0.09）。相反，在严重狭窄的靶血管中，复合与单个 ITA 移植物（5.7%对 3.3%，p = 0.278）以及复合与单个 RA 移植物（11.5%对 29.6%，p = 0.297）的发生率相似。
复合移植物的血管造影结果与靶冠状动脉狭窄的严重程度密切相关。在轻度狭窄的靶血管中，复合移植导致吻合口闭塞或串珠征的发生率高于单个移植。
