Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2012 Oct;144(4):824-9. doi: 10.1016/j.jtcvs.2011.11.021. Epub 2011 Dec 9.
This study compared early and follow-up angiographic results of individual and sequential grafting with the free right internal thoracic artery (RITA).
We reviewed 334 patients who underwent multivessel coronary artery bypass grafting with the free RITA between September 2004 and December 2010. The free RITA was used for individual grafting in 179 patients and for sequential grafting in 155 patients. We compared operative and postoperative variables and early and follow-up angiographic patency rates of distal anastomoses of the free RITA between the groups.
The mean number of distal anastomoses in sequential grafting was 2.2 ± 0.4. The inflow of the free RITA included the aorta (27.4%) and other grafts (72.6%) in the individual group. The inflow of free RITA was exclusively other grafts in the sequential group. Operative mortality and incidence of postoperative complications were not significantly different between groups. Overall patency rate of distal anastomosis of the free RITA was 99.1% at early angiography and 91.8% at follow-up angiography, and the rate did not differ significantly between individual and sequential grafting (early, 98.6% vs 99.3%; follow-up, 93.0% vs 91.2%).
Multivessel coronary artery bypass grafting with the free RITA is safe and useful. Patency rates of distal anastomoses are similar between individual and sequential grafting with the free RITA at early and follow-up angiography. When the RITA cannot be used as an in situ graft for multiple anastomoses, sequential grafting with the free RITA should be considered.
本研究比较了单独使用和序贯使用游离右内乳动脉（RITA）进行早期和随访血管造影的结果。
我们回顾了 2004 年 9 月至 2010 年 12 月期间接受游离 RITA 多支冠状动脉旁路移植术的 334 例患者。179 例患者采用游离 RITA 进行单独移植，155 例患者采用游离 RITA 序贯移植。我们比较了两组患者游离 RITA 远端吻合口的手术和术后变量以及早期和随访血管造影通畅率。
序贯移植中游离 RITA 的平均吻合口数量为 2.2±0.4。游离 RITA 的流入血管包括主动脉（27.4%）和其他移植物（72.6%）在单独组。在序贯组中，游离 RITA 的流入血管仅为其他移植物。两组患者的手术死亡率和术后并发症发生率无显著差异。游离 RITA 远端吻合口的总通畅率在早期血管造影时为 99.1%，在随访血管造影时为 91.8%，两组之间差异无统计学意义（早期：98.6%比 99.3%；随访：93.0%比 91.2%）。
游离 RITA 多支冠状动脉旁路移植术是安全有效的。游离 RITA 单独和序贯移植的远端吻合口通畅率在早期和随访血管造影时相似。当 RITA 不能作为多个吻合口的原位移植物时，应考虑游离 RITA 的序贯移植。
