Paterson Hugh S, Bannon Paul G
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia.
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, NSW, Australia.
Heart Lung Circ. 2018 Feb;27(2):133-137. doi: 10.1016/j.hlc.2017.10.010. Epub 2017 Oct 28.
The use of composite coronary artery bypass grafts from the left internal mammary artery (LIMA) has increased over the last 20 years. Total arterial revascularisation can be achieved with two arterial conduits and is associated with a reduced risk of stroke. However, the traditional coronary bypass graft configurations of the in situ LIMA and aorto-coronary saphenous vein grafts remain as the mainstay of coronary bypass surgery in most centres. Concerns regarding composite Y grafts relate to (1) the adequacy of a single inflow for all coronary bypass grafts; (2) the risk of compromising the LIMA flow to the left anterior descending coronary artery; (3) the effects of competitive flow on graft patency; and (4) the use of sequential coronary anastomoses. The evidence upon which these concerns are based will be discussed along with the evidence relating to the use of the various second conduit options.
在过去20年中，使用来自左乳内动脉（LIMA）的复合冠状动脉旁路移植术的情况有所增加。使用两根动脉导管可实现完全动脉血运重建，且与中风风险降低相关。然而，原位LIMA和主动脉 - 冠状动脉大隐静脉移植的传统冠状动脉旁路移植配置在大多数中心仍然是冠状动脉旁路手术的主要方式。对复合Y形移植的担忧涉及：（1）所有冠状动脉旁路移植的单一血流供应是否充足；（2）影响LIMA向左前降支冠状动脉供血的风险；（3）竞争性血流对移植血管通畅性的影响；以及（4）序贯冠状动脉吻合术的使用。将讨论这些担忧所基于的证据以及与各种第二根导管选择使用相关的证据。
