Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, 180 Fenglin Rd., Shanghai, 200032, PR China.
Shanghai Institute of Cardiovascular Disease, 1609 Xietu Rd., Shanghai, 200032, PR China.
Int J Surg. 2017 Dec;48:99-104. doi: 10.1016/j.ijsu.2017.10.037. Epub 2017 Oct 20.
Previous studies reported the strategy of in situ skeletonised right internal mammary artery (RIMA) grafting to the left anterior descending artery (LAD). However, few reports have focused on assessing RIMA graft patency rate after grafting to the LAD. This study aimed to assess mid-term graft patency of in situ skeletonised RIMA grafting to the LAD versus in situ skeletonised left internal mammary artery (LIMA) grafting to the LAD in a single-centre propensity-matched study.
After propensity score matching, 185 pairs of patients who received first, scheduled, isolated off-pump coronary artery bypass grafting (OPCAB) surgery were assigned to either a RIMA group (patients who received retrosternal crossover in situ skeletonised RIMA-LAD grafting with additional conduits grafting) or a LIMA group (patients who received in situ skeletonised LIMA-LAD grafting with additional conduits grafting). The primary endpoint was mid-term internal mammary artery (IMA) graft failure after grafting to the LAD and was determined by coronary computed tomography angiography examination. The secondary endpoints were mid-term all-cause mortality and the composite mid-term clinical outcome.
The graft patency rate of in situ skeletonised RIMA-LAD graft was not inferior to in situ skeletonised LIMA-LAD graft during a follow-up period of 36.6 ± 12.1 months (97.2% vs. 96.6%, p = 0.752). Kaplan-Meier curves showed a similar cumulative IMA graft failure between the two groups (χ = 0.092, Log-rank p = 0.762). And Cox regression analysis revealed that grouping was not an independent factor for follow-up IMA graft failure after grafting to the LAD (HR = 0.93, 95% CI: 0.68-2.13). Additionally, Kaplan-Meier curves showed similar cumulative survival free from adverse events between the two groups (χ = 2.365, p = 0.124, respectively).
Revascularisation of the LAD using a skeletonised RIMA resulted in excellent mid-term graft patency and clinical outcomes.
先前的研究报告了原位骨骼化右内乳动脉（RIMA）移植至左前降支（LAD）的策略。然而，很少有研究关注 RIMA 移植至 LAD 后的通畅率。本研究旨在评估单中心倾向评分匹配研究中，原位骨骼化 RIMA 移植至 LAD 与原位骨骼化左内乳动脉（LIMA）移植至 LAD 的中期吻合率。
经过倾向评分匹配后，185 对接受首次、计划的、非体外循环冠状动脉旁路移植术（OPCAB）手术的患者被分为 RIMA 组（患者接受胸骨后交叉原位骨骼化 RIMA-LAD 移植，并进行其他血管桥移植）或 LIMA 组（患者接受原位骨骼化 LIMA-LAD 移植，并进行其他血管桥移植）。主要终点是 LAD 吻合后中期内乳动脉（IMA）移植失败，并通过冠状动脉计算机断层血管造影检查确定。次要终点是中期全因死亡率和复合中期临床结果。
在 36.6±12.1 个月的随访期间，原位骨骼化 RIMA-LAD 移植的通畅率不低于原位骨骼化 LIMA-LAD 移植（97.2% vs. 96.6%，p=0.752）。Kaplan-Meier 曲线显示两组累积 IMA 移植失败率相似（χ²=0.092，Log-rank p=0.762）。Cox 回归分析显示，分组不是 LAD 吻合后随访 IMA 移植失败的独立因素（HR=0.93，95%CI：0.68-2.13）。此外，Kaplan-Meier 曲线显示两组累积无不良事件生存率相似（χ²=2.365，p=0.124）。
使用骨骼化 RIMA 对 LAD 进行血运重建可获得良好的中期吻合率和临床结果。
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