Hayashi Yasunari, Ito Toshiaki, Maekawa Atsuo, Sawaki Sadanari, Tokoro Masayoshi, Yanagisawa Junji, Murotani Kenta
Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan
Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, Nakamura-ku, Nagoya, Aichi, Japan.
Interact Cardiovasc Thorac Surg. 2016 Mar;22(3):265-72. doi: 10.1093/icvts/ivv333. Epub 2015 Dec 12.
Few studies have reported the free right internal thoracic artery (RITA) being used in an aorto-coronary fashion. This study aimed to evaluate the free RITA with modified proximal anastomosis in an aorto-coronary fashion.
Between January 2000 and December 2012, 282 patients underwent coronary artery bypass grafting with bilateral internal thoracic arteries for complete revascularization of the left coronary system at our institution. The left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery (LAD) and the RITA was anastomosed to the left circumflex branches (LCX). The RITA was used as a free graft in 213 patients (free group) and as an in situ graft in 69 patients (in situ group). Proximal anastomosis of the free RITA onto the ascending aorta was performed in two different ways. We compared early and late results and graft patency of the free RITA with those of the in situ RITA retrospectively.
The numbers of anastomoses per patient and anastomoses of the RITA were larger in the free group than in the in situ group (P < 0.01). There was no significant difference in postoperative survival between the groups (free group: 93.3% vs in situ group: 90.0%, P = 0.82). The 5-year patency of the free RITA was higher than that of the in situ RITA (97.0 vs 80.3%, P = 0.01). The 5-year patency of the free RITA was comparable with that of the in situ LITA anastomosed to the LAD (97.0 vs 92.9%, P = 0.28).
The free RITA anastomosed to the LCX might have better late patency than the in situ RITA. The free RITA with modified proximal anastomosis in an aorto-coronary fashion enables complete revascularization of the left coronary system with the in situ LITA to the LAD.
很少有研究报道游离右胸廓内动脉（RITA）以主动脉 - 冠状动脉的方式使用。本研究旨在评估以主动脉 - 冠状动脉方式采用改良近端吻合的游离RITA。
2000年1月至2012年12月期间，282例患者在我院接受了冠状动脉旁路移植术，使用双侧胸廓内动脉对左冠状动脉系统进行完全血运重建。左胸廓内动脉（LITA）与左前降支动脉（LAD）吻合，RITA与左旋支分支（LCX）吻合。213例患者将RITA用作游离移植物（游离组），69例患者用作原位移植物（原位组）。游离RITA与升主动脉的近端吻合采用两种不同方式进行。我们回顾性比较了游离RITA与原位RITA的早期和晚期结果及移植物通畅情况。
游离组每位患者的吻合数量及RITA的吻合数量均多于原位组（P < 0.01）。两组术后生存率无显著差异（游离组：93.3% vs原位组：90.0%，P = 0.82）。游离RITA的5年通畅率高于原位RITA（97.0%对80.3%，P = 0.01）。游离RITA的5年通畅率与与LAD吻合的原位LITA相当（97.0%对92.9%，P = 0.28）。
与左旋支吻合的游离RITA可能比原位RITA具有更好的晚期通畅性。以主动脉 - 冠状动脉方式采用改良近端吻合的游离RITA能够通过将原位LITA与LAD吻合实现左冠状动脉系统的完全血运重建。
