Department of Cardiovascular Medicine and Surgery, Cliniques Universitaire St Luc, Brussels, Belgium.
J Thorac Cardiovasc Surg. 2011 Nov;142(5):980-8. doi: 10.1016/j.jtcvs.2011.07.017.
Saphenous vein, in situ right gastroepiploic artery, and right internal thoracic artery grafts are routinely used to revascularize the right coronary artery. Little is known about the predictive value of objective preoperative angiographic parameters on midterm graft patency.
We prospectively enrolled 210 consecutive patients undergoing coronary revascularization. Revascularization of the right coronary artery was randomly performed with the saphenous vein grafts in 81 patients and the right gastroepiploic artery in 92 patients. During the same study period, 37 patients received right coronary artery revascularization with the right internal thoracic artery used in a Y-composite fashion. All patients underwent a protocol-driven coronary angiogram 3 years after surgery. Preoperative angiographic parameters included minimum lumen diameter percent stenosis measured by quantitative angiography. A graft was considered "not functional" with patency scores of 0 to 2 and "functional" with patency scores of 3 or 4.
Angiographic follow-up was 100% complete. A significant difference in the distribution of flow patterns was observed in the 3 groups. In multivariate analysis, the use of a saphenous vein graft was associated with superior graft functionality compared with the other conduits (odds ratio, 6.1; 95% confidence interval, 2.4-15). Graft function was negatively influenced by the minimum lumen diameter (odds ratio, 0.11; confidence interval, 0.05-0.25). In the right gastroepiploic artery and right internal thoracic artery groups, the proportion of functional grafts was higher when the minimum lumen diameter was below a threshold value in the third minimum lumen diameter quartile (0.64-1.30 mm).
Preoperative angiography predicts graft patency in the right gastroepiploic artery and right internal thoracic artery, whereas the flow pattern in saphenous vein grafts is significantly less influenced by quantitative angiographic parameters.
隐静脉、原位胃网膜右动脉和右内乳动脉移植物通常用于右冠状动脉血运重建。关于客观术前血管造影参数对中期移植物通畅性的预测价值知之甚少。
我们前瞻性纳入 210 例连续接受冠状动脉血运重建的患者。81 例患者随机采用隐静脉移植物，92 例患者采用胃网膜右动脉进行右冠状动脉血运重建。在此同期研究期间，37 例患者采用 Y 型复合式右内乳动脉进行右冠状动脉血运重建。所有患者在术后 3 年接受方案驱动的冠状动脉造影。术前血管造影参数包括定量血管造影测量的最小管腔直径百分比狭窄。吻合口通畅评分 0-2 时认为吻合口为“无功能”，吻合口通畅评分 3 或 4 时认为吻合口为“功能”。
血管造影随访率为 100%。3 组之间观察到血流模式分布存在显著差异。多变量分析显示，与其他移植物相比，隐静脉移植物的使用与更好的吻合口功能相关（比值比，6.1；95%置信区间，2.4-15）。最小管腔直径（比值比，0.11；置信区间，0.05-0.25）对吻合口功能产生负面影响。在胃网膜右动脉和右内乳动脉组中，当最小管腔直径处于第三最小管腔直径四分位数的阈值以下（0.64-1.30mm）时，功能吻合口的比例较高。
术前血管造影可预测胃网膜右动脉和右内乳动脉的移植物通畅性，而隐静脉移植物的血流模式受定量血管造影参数的影响显著较小。
