Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
Eur J Cardiothorac Surg. 2013 Oct;44(4):e302-7. doi: 10.1093/ejcts/ezt388. Epub 2013 Jul 31.
The aim of this pilot study was to describe and assess the safety of a novel composite graft technique for coronary artery bypass grafting (CABG) surgery. A saphenous vein is grafted to the left anterior descending artery (LAD) and other anterolateral coronary arteries, creating a saphenous vein bridge (SVB) and the left internal mammary artery (LIMA) is anastomosed to the SVB, distributing the blood flow distally (LIMA-SVB).
All patients who underwent CABG with the LIMA-SVB between 2005 and 2008 at our centre were enrolled in this study. Perioperative data were retrospectively collected from hospital charts, and the clinical follow-up was completed by telephone interview. Graft patency was assessed by computed tomography angiography (CTA) in patients with the longest follow-up time (n = 20).
A total of 256 patients (mean age: 67 ± 12 years; 79% male) received 4.0 ± 1.0 grafts, including 2.2 ± 0.4 distal grafts provided by the LIMA-SVB. Nine (3.5%) deaths and 4 (1.6%) myocardial infarctions (MIs) were noted in the perioperative period. With a median follow-up time of 36 months [inter-quartile range 31-44], 1 (0.5%) MI and 2 (1.0%) strokes were reported. At 51 months post-surgery [47-53], CTA demonstrated a LIMA pedicle (n = 20) and SVB (n = 42) patency rate of 100 and 93%, respectively. Specifically, the LIMA-SVB patency rate was 100% to the LAD and 85% to diagonal arteries. Aortocoronary vein grafts (n = 38) patency rate in the same patients was 87%.
Revascularization of the anterolateral territory using the LIMA-SVB is a promising approach considering its clinical safety and favourable patency rate results. A prospective randomized clinical trial is underway to compare this technique to conventional CABG.
本研究旨在描述和评估一种用于冠状动脉旁路移植术（CABG）的新型复合移植物技术的安全性。大隐静脉被移植到左前降支（LAD）和其他前外侧冠状动脉，形成大隐静脉桥（SVB），左内乳动脉（LIMA）与 SVB 吻合，将血液远端分布（LIMA-SVB）。
回顾性收集了 2005 年至 2008 年期间在我院行 CABG 并采用 LIMA-SVB 技术的所有患者的围手术期数据，并通过电话访谈完成了临床随访。对随访时间最长的 20 例患者进行计算机断层血管造影（CTA）评估桥血管通畅情况。
共 256 例患者（平均年龄：67 ± 12 岁；79%为男性）接受了 4.0 ± 1.0 根移植物，其中 2.2 ± 0.4 根为 LIMA-SVB 提供的远端移植物。围手术期发生 9 例（3.5%）死亡和 4 例（1.6%）心肌梗死（MI）。中位随访时间为 36 个月[四分位距 31-44]，报告了 1 例（0.5%）MI 和 2 例（1.0%）中风。术后 51 个月[47-53]，CTA 显示 LIMA 蒂（n=20）和 SVB（n=42）通畅率分别为 100%和 93%。具体来说，LIMA-SVB 对 LAD 和对角支的通畅率为 100%和 85%。同一患者的主动脉冠状静脉移植物（n=38）通畅率为 87%。
考虑到其临床安全性和良好的通畅率结果，使用 LIMA-SVB 对前外侧区域进行血运重建是一种很有前途的方法。一项比较该技术与传统 CABG 的前瞻性随机临床试验正在进行中。
