Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
J Thorac Cardiovasc Surg. 2014 Feb;147(2):619-24. doi: 10.1016/j.jtcvs.2013.01.031. Epub 2013 Feb 10.
The aim of the study was to determine whether using the in situ internal thoracic artery (ITA) graft ipsilateral to the arteriovenous fistula adversely affects the outcomes after isolated coronary artery bypass grafting (CABG) in the dialysis-dependent patients to answer the concerns of a possible steal and consequent myocardial ischemia.
We categorized 155 dialysis patients undergoing isolated CABG between January 1993 and December 2011 into 108 patients (70%, ipsilateral group) whose left anterior descending artery (LAD) was revascularized with the ITA ipsilateral to the arteriovenous fistula and 47 patients (contralateral group) whose LAD was grafted with the ITA opposite to the fistula, to compare their early and late outcomes.
While 94% of the ipsilateral group had left fistula, 55% of the contralateral group had left fistulas. The LAD was grafted with the left ITA in 94% of the ipsilateral group, whereas it was grafted with left (49%) or right (51%) ITAs in the contralateral group. There was no significant difference in hospital mortality between the groups (ipsilateral 10.2% vs contralateral 10.6%). After follow-up for 55 ± 42 months, the overall survival (ipsilateral 58% vs contralateral 65% at 5 years) and cardiac event-free rates (ipsilateral 74% vs contralateral 68% at 5 years) were also similar between the groups by log-rank tests (P = .90 and P = .07).
Revascularization of the LAD using the in situ ITA graft ipsilateral to the arteriovenous fistula increases neither the operative mortality nor the risks of late death and cardiac events after isolated CABG in dialysis patients.
本研究旨在确定在依赖透析的患者中，使用吻合至动静脉瘘的原位内乳动脉（ITA）桥是否会对单纯冠状动脉旁路移植术（CABG）后的结果产生不利影响，以解答可能存在的盗血和由此导致的心肌缺血问题。
我们将 1993 年 1 月至 2011 年 12 月期间接受单纯 CABG 的 155 例透析患者分为两组：108 例（70%，同侧组）的左前降支（LAD）采用吻合至瘘同侧的 ITA 进行血运重建，47 例（对侧组）的 LAD 采用吻合至瘘对侧的 ITA 进行血运重建，比较两组患者的早期和晚期结局。
同侧组 94%的患者有左侧瘘，对侧组 55%的患者有左侧瘘。同侧组 94%的患者采用左侧 ITA 对 LAD 进行血运重建，而对侧组 49%的患者采用左侧 ITA、51%的患者采用右侧 ITA 对 LAD 进行血运重建。两组患者的院内死亡率无显著差异（同侧组 10.2% vs 对侧组 10.6%）。在 55±42 个月的随访后，两组患者的总体生存率（同侧组 5 年时为 58%，对侧组为 65%）和无心脏事件生存率（同侧组 5 年时为 74%，对侧组为 68%）在对数秩检验中也无显著差异（P=.90 和 P=.07）。
在透析患者中，使用吻合至动静脉瘘的原位 ITA 桥对 LAD 进行血运重建，既不会增加手术死亡率，也不会增加单纯 CABG 后晚期死亡和心脏事件的风险。
