Yang Junfeng, Wang Liangshan, Li Haitao, Liu Changcheng, Li Bo, Li Hui, Liu Rui, Gu Chengxiong
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Heart Lung Circ. 2017 Nov;26(11):1224-1230. doi: 10.1016/j.hlc.2016.10.018. Epub 2016 Nov 30.
Saphenous vein graft (SVG) failure remains the Achilles' heel of coronary artery bypass grafting (CABG) and grafts performed on the right coronary artery (RCA) system always have the worst patency compared with those performed on the left coronary system. The aim of this study was to introduce the distal anastomoses support (DAS) procedure and investigate the effect of DAS on the mid-term graft patency of SVG-PDA.
Between May and September 2013, 100 patients with an RCA severe lesion who underwent isolated OPCABG (CABG alone group, n=50) or CABG with DAS for anastomoses of SVG-PDA (CABG plus DAS group, n=50) were evaluated retrospectively.
Patency rates of SVG-PDA at two years were significantly higher in the CABG plus DAS group compared to the CABG alone group (94.0% vs 74.0%, p = 0.006). However, there was no significant difference between the two groups with regard to freedom from MACCE at two years (92.0±3.8% versus 82.0±5.4%, p=0.08). No death occurred in both groups, and freedom from angina at two years did not differ significantly between two groups (80.0% vs 92.0%, p=0.62). In multivariate logistic regression analysis, diffuse disease was the independent predictor of graft occlusion (OR=11.05, 95% CI 2.14-57.12, p=0.004), but concomitant DAS (OR=0.04, 95% CI 0.003-0.350, p=0.004), proximal stenosis > 75% (OR=0.09, 95% CI 0.02-0.50, p=0.006), and male gender (OR=0.05, 95% CI 0.007-0.301, p=0.001) were protective factors.
Concomitant DAS could improve mid-term patency of SVG-PDA. Adding the DAS procedure to CABG may be a new choice for patients with an RCA severe lesion.
大隐静脉移植血管（SVG）失败仍然是冠状动脉旁路移植术（CABG）的致命弱点，与在左冠状动脉系统进行的移植相比，在右冠状动脉（RCA）系统进行的移植血管通畅率总是最差。本研究的目的是介绍远端吻合支持（DAS）手术，并研究DAS对SVG-PDA中期移植血管通畅率的影响。
回顾性评估2013年5月至9月期间100例患有RCA严重病变的患者，这些患者接受了单纯非体外循环冠状动脉旁路移植术（单纯CABG组，n = 50）或采用DAS进行SVG-PDA吻合的CABG（CABG加DAS组，n = 50）。
与单纯CABG组相比，CABG加DAS组SVG-PDA两年时的通畅率显著更高（94.0%对74.0%，p = 0.006）。然而，两组在两年时无主要不良心血管和脑血管事件（MACCE）的发生率方面无显著差异（92.0±3.8%对82.0±5.4%，p = 0.08）。两组均未发生死亡，两组在两年时无心绞痛的发生率也无显著差异（80.0%对92.0%，p = 0.62）。在多因素逻辑回归分析中，弥漫性病变是移植血管闭塞的独立预测因素（比值比[OR]=11.05，95%可信区间[CI] 2.14 - 57.12，p = 0.004），但同时采用DAS（OR = 0.04，95% CI 0.003 - 0.350，p = 0.004）、近端狭窄>75%（OR = 0.09，95% CI 0.02 - 0.50，p = 0.006）和男性性别（OR = 0.05，95% CI 0.007 - 0.301，p = 0.001）是保护因素。
同时采用DAS可提高SVG-PDA的中期通畅率。在CABG中增加DAS手术可能是患有RCA严重病变患者的一种新选择。
