Aksut Mehmet, Koksal Cengiz, Kocamaz Ozgur, Aksoy Eray, Kara Ibrahim, Onk Alper, Ozkaynak Berk
Kartal Kouyolu Training and Research Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey.
Ann Thorac Cardiovasc Surg. 2012;18(4):331-7. doi: 10.5761/atcs.oa.11.01783. Epub 2012 May 31.
Late occlusion of bypass grafts is one of the main issues associated with long-term survival after coronary artery bypass grafting (CABG) surgery. Left coronary system is generally revascularized using arterial conduits, whereas saphenous venous grafts are used for right coronary system. We investigated the prognostic factors that are related to the patency and risk of occlusion of saphenous venous grafts used for revascularization of diseased right coronary arteries.
92 patients who underwent CABG operation including a right coronary artery (RCA) bypass using saphenous venous graft (SVG) between January 2003 and July 2010 were evaluated retrospectively. Mean time of follow up was 66.9 ± 27.2 months (range 104-13 months). Grafts patencies were investigated using coronary angiography, and associated risk factors for mortality and morbidity were determined during the mid-term and long-term follow up. During the data collection phase, a significant association was noticed between patency of right coronary bypass grafts and site of distal anastomoses on RCA. Thus, patients were divided into two groups, according to the site of anastomosis. Right coronary anastomoses were performed either proximal (Group A, n = 44) or distal (Group B, n = 46) to the crux of the RCA (PDA).
Patency rates were similar in-group A (50% occluded and 50% patent) whereas patency rates were significantly higher in-group B (occluded 16.7%, patent 83.3%, p = 0.001). Mean age was significantly higher in-group A compared to Group B (p <0.05); however, there was no statistically significant difference between the two groups with regard to risk factors associated with cardiovascular disease (p >0.05). Also, mean diameter of the target vessel was significantly higher in-group A (p <0.01).
Based on the results of our study we suggest that even though an appropriate segment for anastomosis is available proximal to the crux of the RCA, right posterior descending artery (PDA) should be preferred for revascularization when RCA is the target vessel in CABG.
冠状动脉旁路移植术（CABG）后，旁路移植物的晚期闭塞是影响长期生存的主要问题之一。左冠状动脉系统一般采用动脉导管进行血运重建，而大隐静脉移植物则用于右冠状动脉系统。我们研究了与用于病变右冠状动脉血运重建的大隐静脉移植物通畅性和闭塞风险相关的预后因素。
回顾性评估了2003年1月至2010年7月期间92例行CABG手术且使用大隐静脉移植物（SVG）进行右冠状动脉（RCA）旁路移植的患者。平均随访时间为66.9±27.2个月（范围为104 - 13个月）。通过冠状动脉造影检查移植物通畅情况，并在中期和长期随访期间确定与死亡率和发病率相关的危险因素。在数据收集阶段，发现右冠状动脉旁路移植物的通畅性与RCA远端吻合部位之间存在显著关联。因此，根据吻合部位将患者分为两组。右冠状动脉吻合在RCA关键部位（PDA）近端（A组，n = 44）或远端（B组，n = 46）进行。
A组的通畅率相似（50%闭塞，50%通畅），而B组的通畅率显著更高（闭塞16.7%，通畅83.3%，p = 0.001）。A组的平均年龄显著高于B组（p <0.05）；然而，两组在与心血管疾病相关的危险因素方面无统计学显著差异（p >0.05）。此外，A组目标血管的平均直径显著更大（p <0.01）。
根据我们的研究结果，我们建议，尽管在RCA关键部位近端有合适的吻合段，但在CABG中以RCA为目标血管进行血运重建时，右后降支动脉（PDA）应优先选择。
