Carrel Thierry, Winkler Bernhard
Department of Cardiovascular Surgery, Inselspital, University of Berne, Freiburgstrasse 18, 3010, Berne, Switzerland.
Gen Thorac Cardiovasc Surg. 2017 Oct;65(10):549-556. doi: 10.1007/s11748-017-0807-8. Epub 2017 Aug 9.
The procedure of coronary artery bypass grafting continues to be the "gold standard" for patients with multivessel coronary artery disease and left main stenosis due to favourable long-term and consistent outcomes despite the advent of new generations of stents. But the targeted better long-term outcome of surgical revascularization over percutaneous interventions depends on several variables and aspects; one of them is the choice of conduits used to bypass the stenosed arteries. Coronary artery bypass surgery has been studied and debated for decades and the same applies to the selection of grafts. Current data provide significant benefits for patients who receive full arterial revascularization using both internal thoracic arteries and, if applicable, the radial artery. Unfortunately, the use of multiple arterial grafts is still not performed widely despite the evidence of superiority over multiple saphenous vein grafts that are still the most used grafts in cardiovascular procedures. In this review article, we present current trends and evidences for graft selection and give an overview of controversial data regarding the comparison of the radial artery and saphenous vein. Additionally, few words are spelt on alternative conduits.
尽管新一代支架问世,但冠状动脉旁路移植术对于多支冠状动脉疾病和左主干狭窄患者而言,仍是“金标准”,因其长期疗效良好且稳定。然而,手术血运重建相对于经皮介入治疗而言,其目标是实现更好的长期疗效,这取决于多个变量和因素;其中之一是用于绕过狭窄动脉的血管移植物的选择。冠状动脉旁路手术已经研究和讨论了数十年,移植物的选择也是如此。目前的数据表明,对于使用胸廓内动脉以及(如适用)桡动脉进行完全动脉血运重建的患者具有显著益处。不幸的是,尽管有证据表明使用多条动脉移植物优于多条大隐静脉移植物(后者仍是心血管手术中最常用的移植物),但多条动脉移植物的使用仍未广泛开展。在这篇综述文章中,我们介绍了移植物选择的当前趋势和证据,并概述了有关桡动脉和大隐静脉比较的争议性数据。此外,还简要提及了替代血管。