Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
J Thorac Cardiovasc Surg. 2016 Sep;152(3):862-869.e2. doi: 10.1016/j.jtcvs.2016.04.054. Epub 2016 Apr 27.
Whether radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival than saphenous vein (SV) remains undetermined.
Study population included a selected low-risk group of 275 subjects undergoing BITA grafting with RA as third arterial conduit (BITA+RA) and 489 undergoing BITA grafting with additional SV graft (BITA+SV). RA was considered only for target stenosis of at least 75%. We finally obtained 275 propensity score-matched pairs for comparison.
Operative mortalities were 1 (0.3%) and 2 (0.7%) for BITA+RA and BITA+SV, respectively (P = .56). After mean follow-up of 10.6 ± 4.8 years, BITA+RA survivals were 97.4% ± 0.9%, 90.3% ± 2.0%, and 81.7% ± 3.2% at 5, 10, and 15 years, respectively, versus 97.0% ± 1.0%, 94.1% ± 1.5%, and 82.1% ± 3.4% (log-rank P = .54; hazard ratio, 1.16; 95% confidence interval, 0.71-1.9). Strategies showed comparable survivals when RA or SV was used to graft the right (P = .79) or left (P = .55) coronary system only. Lack of survival advantage for BITA+RA was confirmed in patients 60 years and younger (P = .80) and older than 60 years (P = .53), with and without diabetes mellitus (P = .89 and P = .54, respectively), and with or without left ventricular dysfunction (P = .95 and P = .65, respectively).
Long-term survival in selected low-risk patients undergoing BITA grafting was not extended by using RA as third arterial conduit in preference to SV.
桡动脉（RA）作为第三条动脉通道，与隐静脉（SV）相比，是否能增加患者的存活率，目前尚无定论。
本研究纳入了 275 名接受双侧胸廓内动脉（BITA）搭桥术并加用 RA 作为第三条动脉通道（BITA+RA）的低危患者，和 489 名接受 BITA 搭桥术并加用 SV 搭桥术（BITA+SV）的患者。RA 仅用于目标狭窄≥75%的患者。最终我们匹配了 275 对患者进行比较。
BITA+RA 组和 BITA+SV 组的手术死亡率分别为 1（0.3%）和 2（0.7%）（P=0.56）。在平均 10.6±4.8 年的随访后，BITA+RA 的生存率分别为：5 年时为 97.4%±0.9%，10 年时为 90.3%±2.0%，15 年时为 81.7%±3.2%；与之相比，BITA+SV 组的生存率分别为：5 年时为 97.0%±1.0%，10 年时为 94.1%±1.5%，15 年时为 82.1%±3.4%（log-rank P=0.54；风险比，1.16；95%置信区间，0.71-1.9）。当 RA 或 SV 仅用于右（P=0.79）或左（P=0.55）冠状动脉系统时，两种策略的生存率相当。在 60 岁及以下（P=0.80）和 60 岁以上（P=0.53）的患者、合并或不合并糖尿病（P=0.89 和 P=0.54）、合并或不合并左心室功能障碍（P=0.95 和 P=0.65）的患者中，BITA+RA 并未显示出生存优势。
在接受 BITA 搭桥术的低危患者中，使用 RA 作为第三条动脉通道并不能延长其长期生存率。
