Songur Murat C, Vural Kerem M, Erdolu Burak, Ozyalcin Sertan
Cardiovascular Surgery Department, Yuksek Ihtisas Hospital of Turkey, Ankara, Turkey.
Thorac Cardiovasc Surg. 2015 Jun;63(4):277-81. doi: 10.1055/s-0033-1356865. Epub 2013 Oct 14.
Choosing a good anastomotic site is crucial during surgical revascularization of the right coronary artery (RCA) system. In many instances of distal and/or sequential main trunk disease, either the right posterior descending coronary artery (RPDA) or distal part of the right main coronary artery (DRCA) is preferred as the target vessel. In this article, the saphenous vein graft (SVG) patency is compared between these two main targets in the long term.
Postoperative control coronary angiograms were obtained and assessed from 452 patients undergoing conventional on-pump coronary artery bypass grafting with either a DRCA (n = 305) or a RPDA graft (n = 147) after an average postoperative period of 5.8 ± 4.3 years (range: 2 months-20 years; a total of 2,627 patient-years).
The overall graft patency was 60%. The 15-year patency rate was better for the DRCA grafts than that for the RPDA grafts (32 ± 5% vs. 19 ± 6%, respectively; p = 0.001), irrespective of target vessel caliber. Other factors adversely influencing the long-term graft patency were poor target vessel quality (p = 0.002) and hypercholesterolemia (p = 0.01). On the other hand, target vessel diameter, diabetes mellitus, hypertension, chronic renal insufficiency, obesity, peripheral arterial disease, or SVG quality were not associated with poor long-term graft patency in these patients having distal-type RCA disease.
In the presence of distal and/or sequential right coronary disease, DRCA may be the target vessel of choice for bypass grafting, rather than the RPDA, mainly for better long-term SVG patency rates in this location.
在右冠状动脉（RCA）系统的外科血管重建术中，选择一个合适的吻合部位至关重要。在许多远端和/或主干连续性疾病的情况下，右冠状动脉后降支（RPDA）或右冠状动脉主干远端部分（DRCA）是首选的靶血管。在本文中，长期比较了这两个主要靶血管的大隐静脉移植血管（SVG）通畅率。
对452例行传统体外循环冠状动脉旁路移植术的患者进行术后冠状动脉造影检查并评估，这些患者移植的靶血管为DRCA（n = 305）或RPDA（n = 147），术后平均时间为5.8±4.3年（范围：2个月至20年；总计2627患者年）。
总体移植血管通畅率为60%。无论靶血管管径如何，DRCA移植血管的15年通畅率均优于RPDA移植血管（分别为32±5%和19±6%；p = 0.001）。其他对移植血管长期通畅率有不利影响的因素包括靶血管质量差（p = 0.002）和高胆固醇血症（p = 0.01）。另一方面，在这些患有远端型RCA疾病的患者中，靶血管直径、糖尿病、高血压、慢性肾功能不全、肥胖、外周动脉疾病或SVG质量与移植血管长期通畅率不佳无关。
在存在远端和/或连续性右冠状动脉疾病的情况下，DRCA可能是旁路移植术的首选靶血管，而非RPDA，主要是因为该部位的SVG长期通畅率更高。
