Gatti Giuseppe, Castaldi Gianluca, Morosin Marco, Tavcar Irena, Belgrano Manuel, Benussi Bernardo, Sinagra Gianfranco, Pappalardo Aniello
Cardiovascular Department, Ospedale di Cattinara, University Hospital of Trieste, via Pietro Valdoni, 7, 34148, Trieste, Italy.
Department of Radiology, University Hospital of Trieste, Trieste, Italy.
Heart Vessels. 2018 Feb;33(2):113-125. doi: 10.1007/s00380-017-1040-1. Epub 2017 Aug 11.
Left-sided coronary revascularization with bilateral internal thoracic artery (BITA) graft is performed usually either with an in situ (double source) or Y-graft configuration (single source). Two hundred fifty-three (mean age, 67.1 ± 9.5 years) patients underwent isolated left-sided coronary revascularization with BITA graft alone at the present authors' institution (2000-2015). Skeletonized BITA grafts were used either in an in situ (n = 199) or Y-graft configuration (n = 54). Forty pairs were identified with the propensity score-matching. Outcomes of the two groups were compared both in unmatched and matched series. Cardiopulmonary exercise testing was performed in five pairs of selected, asymptomatic matched patients having patent BITA grafts at coronary computed tomography angiography. BITA in situ patients had lower risk profiles than BITA Y-graft patients (median EuroSCORE II, 1.9 vs. 2.9%, p = 0.051). In-hospital mortality (5.6 vs. 0, p = 0.0093) and the rates of postoperative complications except deep sternal wound infection were higher in BITA Y-graft patients. However, these differences were not confirmed in matched groups. During the follow-up period (mean, 5.9 ± 4.3 years), between BITA in situ and BITA Y-graft matched patients, there were no differences in non-parametric estimates of freedom from cardiac death (p = 0.6), major adverse cardiac and cerebrovascular events (MACCEs, p = 0.65), and repeat coronary revascularization (p = 0.44). Adjusted risk estimates of MACCEs according to BITA configuration confirmed no superiority of the one configuration over the other (p ≥ 0.44). No significant differences were found at the cardiopulmonary exercise testing. Results of left-sided coronary revascularization with BITA graft alone are independent from BITA configuration, even after stress testing.
左侧冠状动脉血运重建采用双侧胸廓内动脉（BITA）移植时，通常采用原位（双源）或Y形移植构型（单源）。在本研究机构（2000 - 2015年），253例（平均年龄67.1±9.5岁）患者仅接受了BITA移植的孤立左侧冠状动脉血运重建。采用骨骼化BITA移植物，其中原位移植（n = 199）或Y形移植构型（n = 54）。通过倾向评分匹配确定了40对。对未匹配和匹配系列的两组结果进行了比较。对冠状动脉计算机断层扫描血管造影显示BITA移植物通畅的5对选定无症状匹配患者进行了心肺运动试验。原位BITA患者的风险特征低于BITA Y形移植患者（欧洲心脏手术风险评估系统II中位数，1.9%对2.9%，p = 0.051）。BITA Y形移植患者的住院死亡率（5.6%对0，p = 0.0093）和除深部胸骨伤口感染外的术后并发症发生率更高。然而，这些差异在匹配组中未得到证实。在随访期（平均5.9±4.3年），原位BITA和BITA Y形移植匹配患者之间，在无心脏死亡（p = 0.6）、主要不良心脑血管事件（MACCEs，p = 0.65）和再次冠状动脉血运重建（p = 0.44）的非参数估计方面没有差异。根据BITA构型对MACCEs进行的调整风险估计证实，一种构型并不优于另一种构型（p≥0.44）。心肺运动试验未发现显著差异。即使在压力测试后，仅采用BITA移植进行左侧冠状动脉血运重建的结果也与BITA构型无关。
