Huh Jae-Hak, Lee Kyung-Hak, Cho Kwang Ree, Hwang Ho Young, Kim Ki-Bong
Department of Thoracic and Cardiovascular Surgery, Hanseo Hospital, Busan.
Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do.
Ann Thorac Surg. 2017 Jul;104(1):138-144. doi: 10.1016/j.athoracsur.2016.09.104. Epub 2016 Dec 22.
The right gastroepiploic artery (RGEA) has advantages for use as an arterial conduit in coronary artery bypass graft surgery but perioperative spasm often develops. This study assessed the spasm and occlusion rates of RGEA conduits and elucidated the mechanism of reopening of occluded RGEA conduits.
Patients who received an RGEA conduit in coronary artery bypass graft surgery were studied (n = 976; 700 composite, 276 in situ, 16 free grafts; 16 received both in situ and composite grafts). Early, 1-year, and 5-year angiographies were performed in 961 patients (98.5%), 815 patients (83.5%), and 618 patients (63.3%), respectively.
Graft spasm was demonstrated in early angiograms in 72 proximal graft trunks of 1,608 distal anastomoses (4.5%) constructed using an RGEA conduit. Early occlusion rates of composite, in situ, and free RGEA conduits were 1.1%, 2.5%, and 0%, respectively; 8.5%, 7.5%, and 21.4%, respectively, at 1 year; and 10.5%, 14.1%, and 37.5%, respectively, at 5 years. Nineteen of 23 patients who had RGEA conduit occlusions at early angiography (1 occluded anastomosis per patient) were reevaluated at 1 year, and 9 of them (47.4%) had become patent. Of 83 patients with occluded RGEA composite grafts (90 occluded RGEA conduit anastomoses) at 1-year angiography, 8 were reopened at 5 years (8.9%). Progression of native target coronary artery disease was observed in all 8 patients with reopened occluded RGEA conduits at 5 years but not in 9 patients with reopened RGEA conduits at 1 year.
Reopening of occluded RGEA conduits occurred early and midterm postoperatively. Reopening appeared related to recovery from graft spasm, and could occur as late as midterm if associated with progression of native coronary artery disease.
在冠状动脉旁路移植手术中，胃网膜右动脉（RGEA）作为动脉管道使用具有优势，但围手术期常发生痉挛。本研究评估了RGEA管道的痉挛和闭塞率，并阐明了闭塞的RGEA管道重新开放的机制。
对在冠状动脉旁路移植手术中接受RGEA管道的患者进行研究（n = 976；700例复合移植，276例原位移植，16例游离移植；16例接受了原位和复合移植）。分别对961例患者（98.5%）、815例患者（83.5%）和618例患者（63.3%）进行了早期、1年和5年的血管造影。
在使用RGEA管道构建的1608个远端吻合口中，72个近端移植主干在早期血管造影中显示移植痉挛（4.5%）。复合、原位和游离RGEA管道的早期闭塞率分别为1.1%、2.5%和0%；1年时分别为8.5%、7.5%和21.4%；5年时分别为10.5%、14.1%和37.5%。23例在早期血管造影时RGEA管道闭塞的患者（每位患者1个闭塞的吻合口）在1年时进行了重新评估，其中9例（47.4%）已再通。在1年血管造影时83例RGEA复合移植闭塞的患者（90个RGEA管道吻合口闭塞）中，8例在5年时重新开放（8.9%）。5年时，所有8例闭塞的RGEA管道重新开放的患者均观察到自身目标冠状动脉疾病进展，但1年时9例RGEA管道重新开放的患者未观察到。
闭塞的RGEA管道在术后早期和中期重新开放。重新开放似乎与移植痉挛的恢复有关，如果与自身冠状动脉疾病进展相关，可能会迟至中期发生。
