Ohira Suguru, Doi Kiyoshi, Okawa Kazunari, Dohi Masahiro, Yamamoto Tsunehisa, Kawajiri Hidetake, Yaku Hitoshi
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ann Thorac Surg. 2016 Sep;102(3):766-773. doi: 10.1016/j.athoracsur.2016.02.075. Epub 2016 May 4.
This study investigated short-term and long-term results of coronary artery bypass grafting (CABG) with in situ sequential left internal thoracic artery (LITA) grafting to the left circumflex area.
The study divided 452 patients who underwent CABG with bilateral ITA grafting to the left coronary artery into two groups: 191 in the sequential group and 261 in the individual group. The 147 pairs were matched by the propensity score.
In the matched pairs, the rates of off-pump, complete revascularization, and hospital death were comparable between the two groups. Early graft evaluation was performed in 78.6%. There was no occlusion of the sequential LITA graft itself, but 5 complications occurred involving the distal segment of the LITA graft (occlusion, 2; string, 2; and competition, 1), and 3 complications (occlusion, 2; and string, 1) developed in the individual group. Event-free anastomosis rates were 97.8% in the sequential group and 97.4% in the individual group (p = 0.847). Diamond anastomosis of proximal sequential grafting showed a better patency of the distal part of sequential anastomosis compared with a parallel anastomosis of proximal sequential grafting (98.4% vs 90.7%, respectively). The freedom from target lesion revascularization and overall survival at 8 years was 94.6% and 96.3% in the sequential and individual groups, respectively (log-rank p = 0.645) and 80.7% and 77.4% (p = 0.300), respectively.
In situ sequential LITA grafting provides acceptable early graft patency and freedom from repeat revascularization, resulting in excellent survival. This technique is a useful strategy for multivessel revascularization including the left circumflex area.
本研究调查了采用原位序贯左胸廓内动脉（LITA）移植至左旋支区域进行冠状动脉旁路移植术（CABG）的短期和长期结果。
该研究将452例行双侧胸廓内动脉移植至左冠状动脉的CABG患者分为两组：序贯组191例，个体组261例。通过倾向评分匹配147对。
在匹配对中，两组的非体外循环率、完全血运重建率和医院死亡率相当。78.6%的患者进行了早期移植物评估。序贯LITA移植物本身无闭塞，但LITA移植物远端段出现5例并发症（闭塞2例、条索状2例、竞争1例），个体组出现3例并发症（闭塞2例、条索状1例）。序贯组无事件吻合率为97.8%，个体组为97.4%（p = 0.847）。近端序贯移植的菱形吻合与近端序贯移植的平行吻合相比，序贯吻合远端部分的通畅性更好（分别为98.4%和90.7%）。序贯组和个体组8年时靶病变血运重建的自由度和总生存率分别为94.6%和96.3%（对数秩检验p = 0.645），以及80.7%和77.4%（p = 0.300）。
原位序贯LITA移植提供了可接受的早期移植物通畅性和免于再次血运重建，从而获得优异的生存率。该技术是包括左旋支区域在内的多支血管血运重建的有用策略。
