Gökay Seher, Ciçek Davran
Department of Cardiology, Başkent University Alanya Practice and Research Hospital, Antalya, Turkey.
Turk Kardiyol Dern Ars. 2012 Dec;40(8):736-43. doi: 10.5543/tkda.2012.26790.
Coronary bypass graft surgery provides symptomatic relief and a long life expectancy for most patients with coronary artery disease who have suitable vessels. Although arterial conduits are becoming more popular, saphenous vein grafts (SVG) are still frequently used in coronary artery bypass surgery since they are readily available, especially in emergency situations. However, SVG tend to degenerate over time, as nearly half of them develop significant stenosis and nearly 40% of them become completely occluded within a decade. Treatment options for SVG failure include redo-surgery, percutaneous intervention, and/or medical therapy. However, challenges in maintaining graft patency (as a predictor of long-term survival) and interventional complications (e.g., distal embolization, ''no-reflow,'' and higher rates of periprocedural myocardial infarction) are still ongoing problems for cardiologists and cardiovascular surgeons. This review discusses the possible causes of graft failure and the contemporary approaches for improving outcomes in patients undergoing coronary artery bypass graft surgery with at least one SVG.
冠状动脉旁路移植术能为大多数有合适血管的冠心病患者缓解症状并延长预期寿命。尽管动脉移植物越来越受欢迎，但大隐静脉移植物（SVG）在冠状动脉旁路手术中仍经常使用，因为它们容易获取，尤其是在紧急情况下。然而，SVG往往会随着时间推移而退化，近一半的SVG会出现明显狭窄，近40%的SVG会在十年内完全闭塞。SVG失败的治疗选择包括再次手术、经皮介入治疗和/或药物治疗。然而，维持移植物通畅（作为长期生存的预测指标）和介入并发症（如远端栓塞、“无复流”以及围手术期心肌梗死发生率较高）仍是心脏病专家和心血管外科医生面临的持续问题。本综述讨论了移植物失败的可能原因以及改善至少使用一个SVG进行冠状动脉旁路移植术患者预后的当代方法。
