Hwang Ho Young, Kim Ki-Bong
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Ann Cardiothorac Surg. 2018 Sep;7(5):686-689. doi: 10.21037/acs.2018.06.08.
The saphenous vein (SV) has been used as an aortocoronary bypass graft for coronary artery bypass grafting (CABG) for the past 50 years. However, CABG using the aortocoronary SV has shown disadvantages of lower long-term graft patency rates and subsequently worse clinical outcomes, compared with CABG using the internal thoracic artery (ITA). The advantages of CABG using the ITA prompted interest in total arterial revascularization, using the bilateral ITAs and other arterial conduits as composite graft configurations in patients exhibiting multi-vessel disease. Total arterial revascularization using a Y- or T-composite graft based on the ITA increases the length of the arterial graft and allows the extensive use of arterial conduits to revascularize both the left and right coronary territories. Further, it has demonstrated favorable outcomes in terms of angiographic patency rates, myocardial perfusion and thickening by single photon emission computed tomography, and long-term clinical outcomes. However, previous studies describing the use of the SV conduit as a composite graft have produced conflicting results. In this article, a recent surgical strategy of using the SV as part of a composite graft based on the left ITA will be discussed.
在过去50年里，大隐静脉（SV）一直被用作冠状动脉旁路移植术（CABG）的主动脉冠状动脉旁路移植血管。然而，与使用胸廓内动脉（ITA）的CABG相比，使用主动脉冠状动脉大隐静脉的CABG显示出长期移植血管通畅率较低以及随后临床结果较差的缺点。使用ITA进行CABG的优势引发了人们对全动脉血运重建的兴趣，即在患有多支血管疾病的患者中，将双侧ITA和其他动脉管道用作复合移植结构。基于ITA使用Y型或T型复合移植物进行全动脉血运重建可增加动脉移植物的长度，并允许广泛使用动脉管道对左、右冠状动脉区域进行血运重建。此外，在血管造影通畅率、心肌灌注以及单光子发射计算机断层扫描显示的心肌增厚情况和长期临床结果方面，它都显示出良好的效果。然而，先前描述将大隐静脉管道用作复合移植物的研究结果相互矛盾。在本文中，将讨论一种最近的手术策略，即将大隐静脉用作基于左ITA的复合移植物的一部分。
