Bazylev V V, Nemchenko E V, Rosseĭkin E V, Mikuliak A I
Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia.
Angiol Sosud Khir. 2018;24(2):49-55.
The study was aimed at assessing remote (up to 42 months) results of coronary artery bypass grafting (CABG) and revealing flowmetric and angiographic predictors of coronary bypass graft occlusion.
Our retrospective single-centre study included a total of 141 patients undergoing coronary artery bypass grafting (CABG). All patients were subjected to assessment of coronary bypass grafts by means of transit-time flowmetry (TTFM), as well as angiographic control of coronary bypass grafts in the remote period. The duration of follow up amounted to 42 months. We performed flowmetric assessment of blood flow by the following parameters: mean volumetric blood flow velocity (Qmean), peripheral resistance (PR), as well as studied angiographic parameters such as: the degree of proximal stenosis of the bypassed coronary artery (CA), the diameter of the bypassed CA. Competence of bypass grafts after carried out coronaroshuntography (CSG) was determined according to the classification of Fitzgibbon.
We performed flowmetric and angiographic assessment of 235 autoarterial and 117 autovenous bypass grafts. During the follow-up period of up to 42 months we revealed 33 (14%) occluded arterial conduits and 30 (25.6%) venous ones. The Kaplan-Meier analysis demonstrated that the probability of the lack of occlusions of venous grafts amounted to 74.4±5.8%, with that of arterial grafts equalling 86±3.3%, i. e. during the follow-up period of up to 42 months, the probability of occlusion of venous grafts was reliably higher than that of arterial ones (Log Rank=0.006). The Cox regression analysis made it possible to reveal that occlusion of grafts was influenced by an increase in the peripheral resistance index (p=0.033, HR=1.374), a decrease of volumetric blood flow velocity in the graft (Qmean) (p=0.005; HR=0.981), and by the type of the graft (venous) (p=0.001; HR=2.587).
本研究旨在评估冠状动脉旁路移植术（CABG）的远期（长达42个月）结果，并揭示冠状动脉旁路移植血管闭塞的血流测量和血管造影预测因素。
我们的回顾性单中心研究共纳入141例行冠状动脉旁路移植术（CABG）的患者。所有患者均通过渡越时间血流仪（TTFM）对冠状动脉旁路移植血管进行评估，并在远期对冠状动脉旁路移植血管进行血管造影对照。随访时间长达42个月。我们通过以下参数进行血流测量评估：平均容积血流速度（Qmean）、外周阻力（PR），并研究血管造影参数，如：旁路冠状动脉（CA）近端狭窄程度、旁路CA直径。根据Fitzgibbon分类法确定冠状动脉分流造影（CSG）后旁路移植血管的通畅情况。
我们对235条自体动脉旁路移植血管和117条自体静脉旁路移植血管进行了血流测量和血管造影评估。在长达42个月的随访期内，我们发现33条（14%）动脉移植血管闭塞，30条（25.6%）静脉移植血管闭塞。Kaplan-Meier分析表明，静脉移植血管无闭塞的概率为74.4±5.8%，动脉移植血管为86±3.3%，即：在长达42个月的随访期内，静脉移植血管闭塞的概率确实高于动脉移植血管（对数秩检验=0.006）。Cox回归分析显示，移植血管闭塞受外周阻力指数升高（p=0.033，HR=1.374）、移植血管容积血流速度（Qmean）降低（p=0.005；HR=0.981）以及移植血管类型（静脉）（p=0.001；HR=2.587）影响。
1）与静脉冠状动脉旁路移植术相比，在长达42个月的时间内，动脉移植血管在心肌血运重建方面似乎能产生更好的效果；2）使用静脉会使术后每月移植血管闭塞的风险增加2.5倍；3）外周阻力指数（PR）每增加1个单位，术后每月冠状动脉移植血管闭塞的风险就会增加1.3倍；4）容积血流速度（Q）每降低1 ml，术后每月移植血管闭塞的风险就会增加2%。
