Lytle B W, Cosgrove D M, Ratliff N B, Loop F D
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
J Thorac Cardiovasc Surg. 1989 Jun;97(6):826-31.
The excellent results of coronary artery bypass with the internal mammary artery and the increasing numbers of patients who need coronary reoperations, but for whom conventional bypass conduits are not available, have prompted us to evaluate alternative arterial bypass conduits. The right gastroepiploic artery has been used as a coronary bypass graft in 36 patients (32 men), whose ages ranged from 29 to 71 years. Twenty-two patients had had previous coronary bypass grafting and six of these were undergoing their third bypass operation. The right gastroepiploic artery was used as an in situ graft to the right coronary artery or circumflex branches for 17 patients and as an aorta-coronary ("free") graft in 19 patients, six to the left anterior descending or diagonal, six to the circumflex, and seven to the right coronary artery. In conjunction with right gastroepiploic artery grafting, 16 patients received bilateral internal mammary artery grafts and 17 received one internal mammary artery graft. Histologically, right gastroepiploic artery segments from 18 patients could not be distinguished from internal mammary artery segments, and no evidence of atherosclerosis was found. Two patients died in the hospital, one intraoperatively and one 3 months after the operation, of a perioperative stroke. Perioperative morbidity included wound complication in three and reexploration for bleeding in two. At late follow-up 1 to 38 months after operation, two late deaths had occurred and 21 patients were free of symptoms. Postoperative angiography (postoperative interval 1 week to 13 months) was performed in nine grafts, three in situ grafts to the right coronary artery and six free grafts that included two to the left anterior descending, three to the circumflex, and one to the right coronary artery. All right gastroepiploic artery grafts were patient. The right gastroepiploic artery is an arterial conduit that can be used as an in situ graft to posterior coronary vessels and as a free graft to any coronary arterial system. Early graft patency has been excellent, and the histologic similarity between the right gastroepiploic artery and the internal mammary artery suggest that the long-term results will be favorable.
采用乳内动脉进行冠状动脉搭桥手术取得了良好效果，且需要再次进行冠状动脉手术的患者数量不断增加，但这些患者无法使用传统的搭桥血管，这促使我们评估其他动脉搭桥血管。36例患者（32例男性）使用了胃网膜右动脉作为冠状动脉搭桥移植物，患者年龄在29至71岁之间。22例患者曾接受过冠状动脉搭桥手术，其中6例正在接受第三次搭桥手术。17例患者将胃网膜右动脉作为原位移植物用于右冠状动脉或回旋支，19例患者将其作为主动脉 - 冠状动脉（“游离”）移植物，其中6例用于左前降支或对角支，6例用于回旋支，7例用于右冠状动脉。在进行胃网膜右动脉搭桥的同时，16例患者接受了双侧乳内动脉移植，17例患者接受了单侧乳内动脉移植。组织学检查显示，18例患者的胃网膜右动脉段与乳内动脉段无法区分，且未发现动脉粥样硬化迹象。2例患者在医院死亡，1例死于术中，1例死于术后3个月，死因均为围手术期卒中。围手术期并发症包括3例伤口并发症和2例因出血而再次手术。在术后1至38个月的远期随访中，发生了2例晚期死亡，21例患者无症状。9例移植物进行了术后血管造影（术后间隔1周至13个月），其中3例原位移植至右冠状动脉，6例游离移植包括2例至左前降支、3例至回旋支和1例至右冠状动脉。所有胃网膜右动脉移植物均通畅。胃网膜右动脉是一种动脉血管，可作为原位移植物用于冠状动脉后支血管，也可作为游离移植物用于任何冠状动脉系统。早期移植物通畅情况良好，胃网膜右动脉与乳内动脉在组织学上的相似性表明长期效果将是良好的。
