Monsefi Nadejda, Zierer Andreas, Honarpisheh Gazal, Bauer Ralf, Kerl Matthias, Beiras-Fernandez Andres, Moritz Anton
Department of Thoracic and Cardiovascular Surgery, Goethe University Hospital, Frankfurt a.M., Germany.
Department of Diagnostic and Interventional Radiology, Goethe University Hospital, Frankfurt a.M., Germany.
Thorac Cardiovasc Surg. 2016 Apr;64(3):204-10. doi: 10.1055/s-0035-1549009. Epub 2015 Apr 13.
Inferior vein graft patency after coronary artery bypass grafting (CABG) is attributed to various factors. Venous valves may limit flow, cause thrombus formation, and diminish diastolic backflow. The aim of our study was to compare clinical outcome and midterm patency rate of valvulotomized vein grafts and arterial grafts in patients undergoing CABG.
Between 2007 and 2010, valvulotomized saphenous vein segments were used to graft the right coronary artery (RCA) in 147 patients undergoing CABG with mean 2.8 ± 1 arterial and 1.5 ± 0.6 venous anastomoses. Outcome, reintervention, and reoperation were assessed after 4 ± 1.6 years. Intraoperative bypass flow rate was measured before and after valvulotomy of venous bypass grafts in 12 patients. Patency of the grafts was assessed by means of multislice computed tomography (MSCT) in 45 patients.
A total of 102 patients underwent isolated CABG and 45 had combined procedures. In-hospital mortality was 2%. At 4 years' clinical follow-up, 95% of the patients were asymptomatic. Five patients underwent recoronary angiography because of angina pectoris. The MSCT and reangiography patency rate of all valvulotomized saphenous vein grafts was 97.1 versus 95.8% of arterial grafts 18 ± 6 months postoperatively. Intraoperative measurements showed a significant increase (+20.2 mL/min; p = 0.01) of flow in the venous bypass grafts to the RCA after valvulotomy. There were no reoperations at the latest follow-up.
Patients with valvulotomized venous grafts had good clinical outcome. The one-year patency rate of those grafts is comparable to that of arterial grafts. However, long-term results and angiography studies will be needed to strengthen these findings.
冠状动脉旁路移植术（CABG）后下肢静脉移植物通畅性受多种因素影响。静脉瓣膜可能会限制血流、导致血栓形成并减少舒张期反流。我们研究的目的是比较接受CABG患者中瓣膜切开的静脉移植物和动脉移植物的临床结局及中期通畅率。
2007年至2010年期间，147例接受CABG的患者使用瓣膜切开的大隐静脉段移植右冠状动脉（RCA），平均有2.8±1个动脉吻合口和1.5±0.6个静脉吻合口。在4±1.6年后评估结局、再次干预和再次手术情况。对12例患者的静脉旁路移植物进行瓣膜切开前后测量术中旁路血流速率。45例患者通过多层计算机断层扫描（MSCT）评估移植物通畅情况。
共有102例患者接受单纯CABG，45例接受联合手术。住院死亡率为2%。在4年的临床随访中，95%的患者无症状。5例患者因心绞痛接受再次冠状动脉造影。术后18±6个月，所有瓣膜切开的大隐静脉移植物的MSCT和再次血管造影通畅率为97.1%，动脉移植物为95.8%。术中测量显示，瓣膜切开后，RCA静脉旁路移植物的血流显著增加（+20.2 mL/min；p = 0.01）。在最近一次随访中没有再次手术。
瓣膜切开的静脉移植物患者临床结局良好。这些移植物的一年通畅率与动脉移植物相当。然而，需要长期结果和血管造影研究来强化这些发现。
