冠状动脉旁路移植术中移植血管的选择与 1 年通畅率。

Graft selection and one-year patency rates in patients undergoing coronary artery bypass grafting.

机构信息

Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.

出版信息

Ann Thorac Surg. 2010 Jun;89(6):1901-5. doi: 10.1016/j.athoracsur.2010.02.016.

DOI:10.1016/j.athoracsur.2010.02.016

PMID:20494046

Abstract

BACKGROUND

The aim of this study was to assess the angiographic patency rates of grafts used for coronary artery bypass surgery.

METHODS

We reviewed the records of 930 patients who underwent isolated coronary artery bypass grafting between September 2004 and June 2009. Of these patients, 95.1% underwent off-pump coronary artery bypass grafting. Early and 1-year angiographic patency rates of grafts were assessed.

RESULTS

Mean anastomoses per patient were 4.0 +/- 1.3. Operative mortality was 0.5%. Stroke occurred in 2.2% of patients, and 1.3% had mediastinitis. Early and 1-year patency rate of total grafts was 97.4% and 87.5%, respectively. One-year patency rate of the left internal thoracic artery, right internal thoracic artery, radial artery, gastroepiploic artery, and saphenous vein graft was 96.1%, 92.0%, 69.5%, 81.4%, and 82.6%, respectively. One-year patency rates of in situ and free right internal artery graft were not significantly different (p = 0.13). One-year patency rate of the radial artery was significantly worse than that of the free right internal thoracic artery graft (p < 0.01) and saphenous vein graft (p < 0.01).

CONCLUSIONS

Multiple coronary arterial revascularizations in various combinations of grafts were clinically safe and effective for isolated coronary artery bypass surgery. Bilateral internal thoracic artery grafting for the left coronary artery system was the most reliable strategy as shown by angiographic patency rates.

摘要

背景

本研究旨在评估用于冠状动脉旁路移植术的移植物的血管造影通畅率。

方法

我们回顾了 2004 年 9 月至 2009 年 6 月间接受单纯冠状动脉旁路移植术的 930 例患者的记录。这些患者中，95.1%接受了非体外循环冠状动脉旁路移植术。评估了移植物的早期和 1 年血管造影通畅率。

结果

每位患者的平均吻合口数为 4.0±1.3。手术死亡率为 0.5%。2.2%的患者发生卒中，1.3%的患者发生纵隔炎。总移植物的早期和 1 年通畅率分别为 97.4%和 87.5%。左内乳动脉、右内乳动脉、桡动脉、胃网膜动脉和大隐静脉移植物的 1 年通畅率分别为 96.1%、92.0%、69.5%、81.4%和 82.6%。原位和游离右内乳动脉移植物的 1 年通畅率无显著差异（p=0.13）。桡动脉的 1 年通畅率明显差于游离右内乳动脉移植物（p<0.01）和大隐静脉移植物（p<0.01）。