Department of Cardiovascular Diseases, Einstein healthcare Network, Philadelphia, PA, USA.
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Curr Cardiol Rep. 2019 Mar 22;21(5):36. doi: 10.1007/s11886-019-1112-1.
Coronary artery bypass grafting is a preferred strategy for complete coronary revascularization in patients who have multi-vessel coronary artery disease, left ventricular dysfunction, and/or diabetes. Both arterial (internal thoracic artery/radial artery) and venous grafts are utilized to bypass the obstruction in native vessels. Despite having radial arterial grafts as a preferred second conduit for bypass, venous grafts are more commonly used.
We review the existing literature and report the preferred conduit based on a recently published meta-analysis of 6 randomized controlled trials. The analysis concluded that radial artery grafts are associated with fewer adverse cardiac events and better graft patency at 5 years of follow-up. Although saphenous vein grafting is the most commonly used conduit in addition to ITA, current data suggests that total arterial bypass (using RA conduit in addition to ITA) may be the better strategy. Both the US and European consensus guidelines advocate for the use of arterial over SV grafting for most patients.
对于多支冠状动脉疾病、左心室功能障碍和/或糖尿病患者，冠状动脉旁路移植术是完全血运重建的首选策略。动脉（内乳动脉/桡动脉）和静脉移植物都可用于绕过天然血管的阻塞。尽管桡动脉移植物作为旁路的首选第二移植物，但静脉移植物更为常用。
我们回顾了现有文献，并根据最近发表的一项荟萃分析报告了首选的移植物，该分析纳入了 6 项随机对照试验。该分析得出的结论是，桡动脉移植物与较少的不良心脏事件和更好的 5 年随访时的移植物通畅率相关。尽管大隐静脉移植除 ITA 之外是最常用的移植物，但目前的数据表明，全动脉旁路（除 ITA 外还使用 RA 移植物）可能是更好的策略。美国和欧洲的共识指南都主张在大多数患者中使用动脉移植物而非 SV 移植物。
