Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
J Thorac Cardiovasc Surg. 2017 Aug;154(2):457-466.e3. doi: 10.1016/j.jtcvs.2017.03.048. Epub 2017 Mar 24.
We investigated the patency rates of no-touch saphenous vein grafts anastomosed to the left anterior descending artery compared with the left internal thoracic artery. Further, we compared the patency of no-touch vein grafts to the left anterior descending artery with the patency of no-touch vein grafts to other coronary arteries.
Of 2635 consecutive patients undergoing coronary artery bypass grafting between 2003 and 2008, 168 (6.3%) were given at least a saphenous vein graft to the left anterior descending artery to avoid harvesting complications in high-risk patients or in response to a left internal thoracic artery injury. A total of 97 patients were consecutively included after informed consent. A clinical examination and computed tomography angiography were performed on 91 patients at a mean of 6 (4-9) years.
The mean age of patients was 75.6 ± 8.5 years. Postoperatively, 88.7% of patients (86/97) were free of angina. The 91 examined patients had 163 grafts with 286 distal anastomoses. Crude patency, according to distal anastomoses, was 94.4% (270/286). The patency of single versus sequential no-touch vein grafts to the left anterior descending artery was 98% (50/51) versus 92.5% (37/40). The total patency rate was 95.6% (87/91), similar to the reported patency rate for the left internal thoracic artery. The no-touch grafts to the left anterior descending artery versus other coronaries had a patency of 95.6% (87/91) versus 93.8% (183/195), a high similarity confirmed by an equivalence analysis.
In elderly coronary bypass patients with multiple comorbidities, a no-touch saphenous vein graft is a promising substitute for the left internal thoracic artery.
我们研究了非接触式大隐静脉吻合到左前降支的通畅率，与左内乳动脉进行比较。此外，我们比较了非接触式静脉移植物到左前降支的通畅率与非接触式静脉移植物到其他冠状动脉的通畅率。
在 2003 年至 2008 年间连续接受冠状动脉旁路移植术的 2635 例患者中，168 例（6.3%）患者至少接受了一条大隐静脉移植物到左前降支，以避免高危患者的采集并发症或左内乳动脉损伤。在获得知情同意后，共连续纳入 97 例患者。91 例患者在平均 6 （4-9） 年后进行了临床检查和计算机断层血管造影。
患者的平均年龄为 75.6 ± 8.5 岁。术后，88.7%（86/97）的患者无心绞痛。91 例检查患者有 163 个移植物和 286 个远端吻合口。根据远端吻合口，原始通畅率为 94.4%（270/286）。单支与序贯非接触式大隐静脉到左前降支的通畅率分别为 98%（50/51）和 92.5%（37/40）。总通畅率为 95.6%（87/91），与左内乳动脉的报告通畅率相似。非接触式大隐静脉到左前降支与其他冠状动脉的通畅率分别为 95.6%（87/91）和 93.8%（183/195），等效性分析证实了这种高度相似性。
在患有多种合并症的老年冠状动脉旁路移植患者中，非接触式大隐静脉是左内乳动脉的一种有前途的替代物。
