Unal Ertekin U, Cicekcioglu Ferit, Ozen Anil, Yilmaz Metin, Kubat Emre, Iscan Hakki Z, Birincioglu Cemal L
Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Hospital, Ankara, Turkey.
Thorac Cardiovasc Surg. 2015 Jun;63(4):282-7. doi: 10.1055/s-0033-1363495. Epub 2014 Jan 13.
The purpose of this study is to evaluate the patency of radial artery (RA) grafts consistent with the target vessel characteristics.
Between October 2001 and January 2012, 83 symptomatic patients or patients with positive ischemic test results underwent coronary angiography following coronary artery bypass grafting. Of these, 68 patients with 81 RA grafts at a mean 49.2 ± 31.9 months (range, 1-137 months) were evaluated. According to the location and degree of proximal stenosis, 5-year graft patency was determined by Kaplan-Meier analysis. The relationships between RA graft patency and degree of proximal stenosis, target vessel location, and inflow characteristics of grafts were assessed by means of Cox proportional hazard models.
Mean age of the patients was 56.4 ± 10.2 years. The period between the operation and postoperative coronary angiography was 49.2 ± 31.9 months (range, 1-137 months; median, 48.8 months). There was no impact on RA patency with regard to preoperative characteristics of the patients. RA patency was higher for left coronary system compared with right system (p = 0.038; 85.5 vs. 65.4%). In addition, patency rate was statistically higher for the proximal stenosis ≥ 90% (odds ratio, 3.65; 95% confidence interval, 1.20-11.07; p = 0.018). Kaplan-Meier patency analysis showed a patency of RA as 79.2% at 5 years.
RA graft patency differs with degree of preoperative native coronary artery stenosis and location of target vessel. RA grafts to not severely stenosed (< 90%) coronary system and to the right coronary territory carry a remarkably high risk of graft failure.
本研究的目的是评估与靶血管特征相符的桡动脉(RA)移植物的通畅情况。
在2001年10月至2012年1月期间,83例有症状的患者或缺血试验结果呈阳性的患者在冠状动脉旁路移植术后接受了冠状动脉造影。其中,对68例患者的81条RA移植物进行了评估,平均随访时间为49.2±31.9个月(范围为1 - 137个月)。根据近端狭窄的部位和程度,采用Kaplan-Meier分析确定5年移植物通畅率。通过Cox比例风险模型评估RA移植物通畅率与近端狭窄程度、靶血管位置以及移植物流入特征之间的关系。
患者的平均年龄为56.4±10.2岁。手术至术后冠状动脉造影的时间为49.2±31.9个月(范围为1 - 137个月;中位数为48.8个月)。患者的术前特征对RA通畅情况没有影响。左冠状动脉系统的RA通畅率高于右冠状动脉系统(p = 0.038;85.5%对65.4%)。此外,近端狭窄≥90%时的通畅率在统计学上更高(优势比为3.65;95%置信区间为1.20 - 11.07;p = 0.018)。Kaplan-Meier通畅分析显示,RA在5年时的通畅率为79.2%。
RA移植物的通畅情况因术前自身冠状动脉狭窄程度和靶血管位置而异。移植到狭窄程度不严重(<90%)的冠状动脉系统和右冠状动脉区域的RA移植物发生移植失败的风险显著较高。