Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.
Ann Thorac Surg. 2011 Apr;91(4):1159-64. doi: 10.1016/j.athoracsur.2010.12.031.
When the bilateral internal thoracic arteries are grafted to the left coronary arteries, it remains controversial whether the better conduit is provided by grafting the saphenous vein graft (SVG) or the gastroepiploic artery (GEA) to the right coronary artery territory. From the beginning of the present study, we consistently used the GEA in a skeletonized fashion using ultrasound scissors.
From January 2002 to December 2009, 320 consecutive patients with triple-vessel disease underwent in situ bilateral internal thoracic artery grafting to the left coronary arteries. Among the 320 patients, of whom 229 underwent GEA grafting to the right coronary artery and 91 SVG grafting, 85 propensity score-matched pairs were identified (C statistic, 0.68 [p < 0.001]).
The mean follow-up duration was 5.1 ± 2.2 years. Seven-year freedom from death from all causes was 96.0% in the GEA group and 82.2% in the SVG group (p = 0.03); the rate of freedom from cardiac events (cardiac death, myocardial infarction, angina pectoris, repeat intervention, and heart failure) was 89.3% in the GEA group and 77.5% in the SVG group (p = 0.048). Multivariate Cox proportional hazard regression analysis showed that SVG use (without GEA) (p = 0.04; hazard ratio, 0.31; 95% confidence interval, 0.11 to 0.94) and smoking history (p = 0.02; hazard ratio, 0.22; 95% confidence interval, 0.07 to 0.81) were independent predictors of late cardiac event.
Skeletonized GEA grafting to the right coronary artery system is better than SVG grafting in patients with left-sided bilateral internal thoracic arterial grafts.
当双侧内乳动脉被移植到左冠状动脉时，将隐静脉移植物（SVG）或胃网膜动脉（GEA）移植到右冠状动脉区域提供更好的移植物仍然存在争议。从本研究开始，我们一直使用超声剪刀对 GEA 进行游离化处理。
从 2002 年 1 月至 2009 年 12 月，320 例三血管病变患者接受了原位双侧内乳动脉移植到左冠状动脉。在这 320 例患者中，229 例行 GEA 移植到右冠状动脉，91 例行 SVG 移植，共配对了 85 对符合倾向评分的患者（C 统计量为 0.68[P<0.001]）。
平均随访时间为 5.1±2.2 年。在 GEA 组中，7 年全因死亡率为 96.0%，SVG 组为 82.2%（P=0.03）；在 GEA 组中，无心脏事件（死亡、心肌梗死、心绞痛、再次介入和心力衰竭）的 7 年生存率为 89.3%，SVG 组为 77.5%（P=0.048）。多变量 Cox 比例风险回归分析显示，SVG 使用（无 GEA）（P=0.04；风险比，0.31；95%置信区间，0.11 至 0.94）和吸烟史（P=0.02；风险比，0.22；95%置信区间，0.07 至 0.81）是晚期心脏事件的独立预测因素。
在左侧双侧内乳动脉移植的患者中，游离化 GEA 移植到右冠状动脉系统优于 SVG 移植。
