Jung Yochun, Ahn Byoung Hee, Kim Gwan Sic, Jeong In Seok, Lee Kyo Seon, Song Sang Yun, Na Kook Joo, Oh Sang Gi
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea.
J Cardiothorac Surg. 2016 Nov 28;11(1):157. doi: 10.1186/s13019-016-0554-4.
Coronary artery bypass grafting (CABG) with a composite Y-graft made of the left internal thoracic artery (LITA) and another arterial graft has a risk for hypoperfusion. Changes over time in the diameter of the LITA anastomosed to the left anterior descending coronary artery (LAD) are not known.
Data were collected for 71 patients who had undergone coronary angiography (CAG) immediately and at 1 year following off-pump CABG with a composite Y-graft made of the LITA and either the radial artery or the right gastroepiploic artery. These patients were divided into 2 groups depending on the degree of LAD stenosis. Group 1 (n = 28) consisted of patients with complete occlusion of the LAD. Group 2 (n = 43) consisted of patients with <90% stenosis of the LAD. The clinical state and luminal diameter of the LITA on immediate postoperative and postoperative 1-year CAG were compared and analyzed.
On the immediate postoperative CAG, mean LITA diameter of Group 1 was larger than that of Group 2 (2.09 ± 0.53 vs. 1.61 ± 0.33 mm, P = 0.01). Mean LITA diameter 1 year following CABG was also larger in Group 1 than in Group 2 (2.49 ± 0.31 vs. 2.10 ± 0.45 mm, P = 0.005). Both groups showed significant increases in the LITA diameters at postoperative 1 year.
The LITA used as a composite Y-graft underwent remodeling, resulting in a larger diameter, to supply adequate myocardial blood. The degree of change in luminal diameter varied according to the severity of the LAD stenosis.
采用由左乳内动脉（LITA）和另一根动脉移植物制成的复合Y形移植物进行冠状动脉旁路移植术（CABG）存在灌注不足的风险。与左前降支冠状动脉（LAD）吻合的LITA直径随时间的变化尚不清楚。
收集了71例行非体外循环CABG并采用由LITA与桡动脉或右胃网膜动脉制成的复合Y形移植物的患者的数据，这些患者在术后即刻及术后1年接受了冠状动脉造影（CAG）。根据LAD狭窄程度将这些患者分为2组。第1组（n = 28）由LAD完全闭塞的患者组成。第2组（n = 43）由LAD狭窄<90%的患者组成。比较并分析术后即刻及术后1年CAG时LITA的临床状态和管腔直径。
术后即刻CAG时，第1组的平均LITA直径大于第2组（2.09±0.53 vs. 1.61±0.33 mm，P = 0.01）。CABG术后1年第1组的平均LITA直径也大于第2组（2.49±0.31 vs. 2.10±0.45 mm，P = 0.005）。两组在术后1年时LITA直径均显著增加。
用作复合Y形移植物的LITA发生了重塑，导致直径增大，以供应充足的心肌血液。管腔直径的变化程度根据LAD狭窄的严重程度而异。
