Molardi Alberto, Nicolini Francesco, Benassi Filippo, Gallingani Alan, Gherli Tiziano, Spaggiari Igino
Azienda Ospedaliero-Universitaria di Parma.
Acta Biomed. 2014 May 9;85(1):57-9.
The optimal conduit of second choice in surgical coronary revascularization remains a matter of debate. Radial artery grafts are believed to have a better patency rate than the saphenous vein grafts, although no conclusive results have been reported. This report describes the late result of a coronary revascularization with sequential venous bypass performed 30 years earlier.
An 80-year-old woman was admitted for dyspnoea on exertion and recent-onset angina due to severe aortic valve stenosis. Thirty years earlier, the patient had undergone revascularization with coronary bypass grafting performed using a sequential saphenous vein graft anastomosed on first diagonal branch and on left anterior descending coronary artery. Coronary angiography showed the occlusion of the native left anterior descending artery and the good patency of the previous described sequential vein graft.
Surgical inspection confirmed the patency and the soft pliability of the venous graft and the surgeon decided to do not replace the previous graft with a pedicled LIMA (Left Internal Mammary Artery) graft. The patient underwent 21-mm biological Edwards Perimount Magna Ease prosthesis implantation. Postoperative course was uneventful and the patient was discharged on the seventh day after surgery.
This case report demonstrated the potential extreme long-term patency of a sequential saphenous vein graft in coronary bypass surgery, raising the question if vein grafts should be really considered the conduits of last resort for coronary artery bypass surgery. Long-term follow-up of randomized trials comparing radial artery versus saphenous vein grafts are warranted in order to give conclusive answers to this ongoing debate.
在外科冠状动脉血运重建中，第二选择的最佳血管 conduit 仍存在争议。尽管尚无确凿结果报道，但桡动脉移植物被认为比大隐静脉移植物具有更高的通畅率。本报告描述了 30 年前进行的序贯静脉搭桥冠状动脉血运重建的晚期结果。
一名 80 岁女性因劳力性呼吸困难和近期因严重主动脉瓣狭窄出现的心绞痛入院。30 年前，该患者接受了冠状动脉搭桥血运重建术，使用序贯大隐静脉移植物吻合于第一对角支和左前降支冠状动脉。冠状动脉造影显示，自身左前降支动脉闭塞，前述序贯静脉移植物通畅良好。
手术检查证实静脉移植物通畅且质地柔软，外科医生决定不使用带蒂左内乳动脉（LIMA）移植物替换先前的移植物。患者接受了 21 毫米生物 Edwards Perimount Magna Ease 假体植入。术后过程顺利，患者于术后第七天出院。
本病例报告证明了序贯大隐静脉移植物在冠状动脉搭桥手术中可能具有极长期的通畅性，引发了关于静脉移植物是否真的应被视为冠状动脉搭桥手术的最后选择血管 conduit 的问题。有必要对比较桡动脉与大隐静脉移植物的随机试验进行长期随访，以便对这场持续的辩论给出确凿答案。
