Sugimura Yukiharu, Toyama Masaaki, Katoh Masanori, Kotani Mitsuhisa, Kato Yuji, Hisamoto Kazuhiro
Department of Cardiovascular Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
Asian Cardiovasc Thorac Ann. 2011 Apr;19(2):119-22. doi: 10.1177/0218492311400101.
The efficacy of using composite arterial Y-grafts in off-pump coronary artery bypass has not been established. We assessed graft patency, long-term clinical outcomes, and the indications for composite arterial Y-grafting by reviewing 53 patients who underwent primary isolated elective off-pump coronary artery bypass with composite arterial Y-grafts between January 2002 and December 2008. Coronary angiography or 64-slice multidetector computed tomographic coronary angiography was used to assess graft patency. Follow-up ranged from 18 to 97 months. The rates of mortality, graft failure, and recurrence of ischemic heart disease were 0%, 22.6%, and 13.2%, respectively. Only 4 (7.5%) patients required additional procedures (percutaneous coronary interventions or repeat surgery) because of graft failure. A significantly higher rate of graft failure was evident when one end of the composite graft was anastomosed to a 75% stenosed branch of a native coronary artery and the other end to a branch with >90% stenosis. The long-term patency of composite arterial Y-grafts in off-pump coronary artery bypass requires proper judgment of the indications.
在非体外循环冠状动脉旁路移植术中使用复合动脉Y形移植物的疗效尚未得到证实。我们通过回顾2002年1月至2008年12月期间接受复合动脉Y形移植物进行初次孤立择期非体外循环冠状动脉旁路移植术的53例患者，评估了移植物通畅情况、长期临床结局以及复合动脉Y形移植的适应证。采用冠状动脉造影或64层多排螺旋计算机断层扫描冠状动脉造影评估移植物通畅情况。随访时间为18至97个月。死亡率、移植物失败率和缺血性心脏病复发率分别为0%、22.6%和13.2%。仅有4例（7.5%）患者因移植物失败需要进行额外的手术（经皮冠状动脉介入治疗或再次手术）。当复合移植物的一端吻合至自身冠状动脉75%狭窄的分支，另一端吻合至狭窄>90%的分支时，移植物失败率明显更高。非体外循环冠状动脉旁路移植术中复合动脉Y形移植物的长期通畅需要对适应证进行恰当判断。
