Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan.
Ann Thorac Surg. 2013 Jul;96(1):90-5. doi: 10.1016/j.athoracsur.2013.04.018. Epub 2013 May 31.
There is at present no accurate figure for the long-term patency rate of the skeletonized gastroepiploic artery (GEA).
From January 2002 to July 2012, 956 consecutive patients underwent isolated off-pump coronary artery bypass graft (OPCABG) surgery at our institution. Of these, the 424 who underwent GEA grafting and postoperative GEA graft evaluation were the subjects of the present study. Of these 424 subjects, 155 (36.6%) underwent long-term outpatient evaluation using multidetector computed tomography angiography.
No patient was converted from off pump to on pump surgery. Overall 30-day mortality was 0.5% (2 of 424). The overall early (4 to 21 days after surgery) patency rate of the skeletonized GEA was 98.2% (599 of 610 anastomoses). A total of 215 GEA anastomoses, including 55 sequential bypasses, were followed for long-term evaluation, of which 12, including three sequential bypasses, were found to be occluded. The overall patency rate in skeletonized GEA grafting over a mean follow-up period of 73 months was 94.4% (203 of 215). The cumulative patency rate of the skeletonized GEA was 97.8% at 30 days, 96.7% at 1 year, 96.0% at 3 years, 94.7% at 5 years, and 90.2% at 8 years after surgery. Multivariate Cox proportional hazard regression analysis showed that target vessel stenosis (p = 0.008, hazard ratio 0.086, 95% confidence interval: 0.014 to 0.53) was the only independent predictor of late graft occlusion.
We demonstrated an accurate long-term patency rate for the skeletonized GEA superior to that for pedicled GEA or saphenous vein graft. A low-grade degree of target vessel stenosis was the only risk factor for late GEA occlusion.
目前尚无关于游离胃网膜动脉（GEA）长期通畅率的确切数据。
从 2002 年 1 月至 2012 年 7 月，我院对 956 例患者行非体外循环冠状动脉旁路移植术（OPCABG），其中 424 例行 GEA 移植并进行术后 GEA 移植评估，作为本研究的对象。其中，155 例（36.6%）接受多层螺旋 CT 血管造影（MDCTA）的长期门诊评估。
无患者由非体外循环转为体外循环手术。总的 30 天死亡率为 0.5%（2/424）。游离 GEA 的整体早期（术后 4 至 21 天）通畅率为 98.2%（610 个吻合口中的 599 个）。共对 215 个 GEA 吻合口（包括 55 个序贯旁路）进行了长期评估，其中 12 个吻合口（包括 3 个序贯旁路）发现闭塞。在平均 73 个月的随访中，游离 GEA 移植的整体通畅率为 94.4%（215 个中的 203 个）。游离 GEA 的累积通畅率在术后 30 天为 97.8%，1 年为 96.7%，3 年为 96.0%，5 年为 94.7%，8 年为 90.2%。多变量 Cox 比例风险回归分析显示，靶血管狭窄（p = 0.008，风险比 0.086，95%置信区间：0.014 至 0.53）是晚期移植物闭塞的唯一独立预测因素。
我们证明了游离 GEA 的长期通畅率准确，优于带蒂 GEA 或隐静脉移植物。低等级的靶血管狭窄是 GEA 晚期闭塞的唯一危险因素。
