三支动脉桥在多支动脉搭桥策略中的重要性。
Importance of the third arterial graft in multiple arterial grafting strategies.
机构信息
Department of Cardiovascular Surgery, Cliniques St Luc, Bouge and the Department of Cardiovascular Medicine and Surgery, Cliniques Universitaire St Luc, Brussels, Belgium.
出版信息
Ann Cardiothorac Surg. 2013 Jul;2(4):475-80. doi: 10.3978/j.issn.2225-319X.2013.07.01.
BACKGROUND
The long-term benefit of multiple arterial grafts for coronary artery bypass (CABG) is not clear. This protocol was elaborated to see if multiple arterial grafts would provide better long-term outcomes when compared with conventional strategies.
METHODS
Prospective data was collected for 588 patients undergoing isolated CABG between 1985 and 1995. We analyzed long term survival and freedom from cardiac death. The analysis compared patients with BITA grafting receiving a right gastro-epiploic artery (RGEA) versus those receiving a saphenous vein graft (SVG) as a third conduit. Cox proportional hazards modelling was used to adjust for relevant confounders.
RESULTS
The mean age was 59±9 years and 49% received BITA. Mean follow-up was 16.1±5.4 years. Multivariable analysis revealed in that patients receiving the RGEA as a third conduit had superior overall survival (HR, 0.46; P=0.015) and cardiac survival (HR, 0.20; P=0.005) compared to those receiving an SVG.
CONCLUSIONS
In our experience, the use of multiple arterial grafting is independently associated with superior outcomes. Furthermore, the use of a third arterial conduit targeted to the RCA should be considered to improve long-term survival.
背景
多支动脉桥用于冠状动脉旁路移植术（CABG）的长期获益尚不清楚。本方案旨在探讨多支动脉桥是否比传统策略提供更好的长期结果。
方法
收集了 1985 年至 1995 年间接受单纯 CABG 的 588 例患者的前瞻性数据。我们分析了长期生存和无心脏死亡的情况。该分析比较了接受右胃网膜动脉（RGEA）作为第三根桥接血管的双侧胸廓内动脉（BITA）移植患者与接受大隐静脉桥接血管（SVG）作为第三根桥接血管的患者。采用 Cox 比例风险模型调整相关混杂因素。
结果
患者的平均年龄为 59±9 岁，49%接受了 BITA。平均随访时间为 16.1±5.4 年。多变量分析显示，接受 RGEA 作为第三根桥接血管的患者具有更好的总体生存率（HR，0.46；P=0.015）和心脏生存率（HR，0.20；P=0.005）。
结论
根据我们的经验，使用多支动脉桥与更好的结果独立相关。此外，应考虑使用第三根动脉桥接血管（靶向 RCA）来提高长期生存率。
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