Lev-Ran Oren, Matsa Menachem, Ishay Yaron, Shabtai Amir, Vodonos Alina, Sahar Gideon
Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
Asian Cardiovasc Thorac Ann. 2015 Jun;23(5):543-51. doi: 10.1177/0218492315573360. Epub 2015 Feb 20.
Retroaortic right internal thoracic artery grafting has failed to gain popularity. We aimed to delineate patient correlates of eligibility, distribution of targets, and effects of target remoteness on outcome and risk of retroaortic bleeding.
Data of 861 patients undergoing skeletonized bilateral internal thoracic artery grafting (2007-2012) were analyzed according to retroaortic (n = 300) or T-graft configuration. Retroaortic graft subgroups were categorized according to proximal (first obtuse marginal, ramus) or distal (2nd, 3rd, or sequential 1st-2nd obtuse marginal) circumflex artery targets.
LOESS curve analyses revealed that taller patients had a higher likelihood of retroaortic grafting. The distribution of 337 retroaortic graft targets (300 patients) was first obtuse marginal in 74.5%, 2nd marginal in 12.4%, ramus in 11.2%, 3rd marginal in 1.9% and sequential 1st-2nd marginal in 12.3%. The success rate in reaching proximal and distal circumflex artery targets was 97% and 30%, respectively, 5-year survival (92.2%) and freedom from major adverse cardiac and cerebrovascular events (85.8%) were comparable between proximal and distal retroaortic graft subgroups. Distal circumflex artery targets had no effect on the occurrence of major adverse cardiac and cerebrovascular events. The incidence of retroaortic bleeding from skeletonized retroaortic grafts was 0.6%.
Taller patients have a greater likelihood of qualifying for retroaortic grafting. This technique is highly reproducible for proximal but not distal circumflex artery targets. Distal circumflex artery targets are not independent correlates of early or late adverse outcomes. The risk of retroaortic bleeding is low despite retroaortic right internal thoracic artery skeletonization.
主动脉后右胸廓内动脉移植术未能广泛应用。我们旨在明确符合条件的患者相关因素、靶血管分布以及靶血管距离对主动脉后移植术结局和主动脉后出血风险的影响。
根据主动脉后（n = 300）或T型移植构型，分析861例行骨骼化双侧胸廓内动脉移植术（2007 - 2012年）患者的数据。主动脉后移植亚组根据近端（第一钝缘支、分支）或远端（第二、第三或连续第一 - 第二钝缘支）回旋支动脉靶血管进行分类。
局部加权回归曲线分析显示，身材较高的患者进行主动脉后移植的可能性更高。337个主动脉后移植靶血管（300例患者）的分布情况为：第一钝缘支占74.5%，第二钝缘支占12.4%，分支占11.2%，第三钝缘支占1.9%，连续第一 - 第二钝缘支占12.3%。到达近端和远端回旋支动脉靶血管的成功率分别为97%和30%，近端和远端主动脉后移植亚组之间的5年生存率（92.2%）和无重大不良心脑血管事件生存率（85.8%）相当。远端回旋支动脉靶血管对重大不良心脑血管事件的发生无影响。骨骼化主动脉后移植术的主动脉后出血发生率为0.6%。
身材较高的患者进行主动脉后移植的可能性更大。该技术对于近端而非远端回旋支动脉靶血管具有高度可重复性。远端回旋支动脉靶血管并非早期或晚期不良结局的独立相关因素。尽管进行了主动脉后右胸廓内动脉骨骼化，但主动脉后出血风险较低。
