右内乳动脉与胃网膜右动脉 Y 型吻合至左内乳动脉的比较。

Comparison of right internal thoracic artery and right gastroepiploic artery Y grafts anastomosed to the left internal thoracic artery.

机构信息

Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Seoul, Republic of Korea.

出版信息

Ann Thorac Surg. 2010 Sep;90(3):744-50; discussion 751-2. doi: 10.1016/j.athoracsur.2010.03.109.

DOI:10.1016/j.athoracsur.2010.03.109

PMID:20732489

Abstract

BACKGROUND

Early and 1-year results of arterial Y composite grafts anastomosed to the in situ left internal thoracic artery were studied.

METHODS

Three hundred twelve patients who underwent off-pump coronary artery bypass using arterial Y composite grafts for revascularization of the left coronary artery territory were analyzed. A skeletonized right internal thoracic artery (RITA) or right gastroepiploic artery (RGEA) was anastomosed to the side of the left internal thoracic artery to construct a Y composite graft. Propensity-matched analysis was used to match patients using RITA (RITA group, n = 102) with patients using RGEA (RGEA group, n = 102). Postoperative coronary angiographies were performed early (200 of 204; 1.8 +/- 1.7 days) and 1 year (171 of 204, 11.3 +/- 2.5 months) postoperatively.

RESULTS

There were no differences in postoperative mortalities (1 of 102 versus 2 of 102; p = 1.000) and morbidities including atrial fibrillation, mediastinitis, and perioperative myocardial infarction between the RITA and RGEA groups (not significant). Early and 1-year postoperative angiographies showed that there were no significant differences in patency rate between the two groups (early, 99.4% versus 99.3%; p = 1.000; 1-year, 95.4% versus 97.4%; p = 0.251). When the early and 1-year patency rates were compared based on the side-arm graft used, there were no differences in patency rates of RITA versus RGEA grafts between the two groups (early, 99.4% versus 100%; p = 1.000; 1-year, 96.5% versus 97.7%; p = 0.724).

CONCLUSIONS

Construction of Y composite grafts using the RITA or RGEA showed comparable results including patency rates early and 1 year postoperatively.

摘要

背景

研究了原位左内乳动脉吻合的动脉 Y 复合移植物的早期和 1 年结果。

方法

分析了 312 例接受非体外循环冠状动脉旁路移植术的患者，这些患者使用动脉 Y 复合移植物进行左冠状动脉区域的血运重建。游离右侧胸廓内动脉（RITA）或右侧胃网膜动脉（RGEA）与左内乳动脉吻合构建 Y 复合移植物。采用倾向性匹配分析，将使用 RITA 的患者（RITA 组，n=102）与使用 RGEA 的患者（RGEA 组，n=102）进行匹配。术后早期（200 例中有 180 例；1.8±1.7 天）和 1 年（204 例中有 171 例；11.3±2.5 个月）进行术后冠状动脉造影。

结果

两组术后死亡率（1/102 与 2/102；p=1.000）和房颤、纵隔炎和围手术期心肌梗死等并发症发生率均无差异（无显著性）。早期和 1 年的术后血管造影显示，两组的通畅率无显著差异（早期，99.4%与 99.3%；p=1.000；1 年，95.4%与 97.4%；p=0.251）。当根据侧支移植物比较早期和 1 年的通畅率时，两组 RITA 与 RGEA 移植物的通畅率无差异（早期，99.4%与 100%；p=1.000；1 年，96.5%与 97.7%；p=0.724）。