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[双侧桡动脉作为冠状动脉旁路移植术血管桥的中期多中心研究结果]

[Mid-term multi-center outcomes of bilateral radial artery as conduits in coronary artery bypass grafting].

作者信息

Chen X J, Zheng B S, Zhang Y, Qiao C H, Cao Y, Liu D B, Wei X, Ling Y P, Li W D, Huang K L, Wu Z, Yu C, Zhou J W, Guo H P, Hu M S, Guo N R, Yang W K, Lu H H, Meng Z L

机构信息

Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

Department of Cardiac Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2019 Apr 9;99(14):1069-1074. doi: 10.3760/cma.j.issn.0376-2491.2019.14.007.

Abstract

To evaluate the mid-term outcomes of bilateral radial artery (BRA) grafts in coronary artery bypass grafting (CABG). All perioperative medical records and follow-up results of CABG with BRA grafts in multi-centers of China were analyzed retrospectively. A total of 211 patients (170 males and 41 females) underwent CABG grafting with BRA conduits between August 2013 and September 2018, with a mean age of (56.5±9.7) years old (rang 41 to 73 years). There were 161 cases of triple-vessel disease and 50 cases of two-vessel disease. Ninety patients had diabetes mellitus (DM), 35 patients with peripheral vascular disease, 4 patients with chronic obstructive pulmonary disease and 11 with heart valve disease. Two patients underwent off-pump CABG and 209 patients accepted on-pump CABG with commitment valve surgery. There were 210 cases of total arterial revascularization and 161 cases using left thoracic artery conduits, with a graft number of 2-4 (2.7±0.9). No operation-related death occurred, atrial fibrillation happened in 12 patients, hemothorax in 7 cases, and forearm hematoma in one case, hypoxemia in 13 cases and pneumonia in one case. The duration of mechanical ventilation was (8.3±4.7) hours and the mean hospital length of stay was (7.1±2.9) days. Follow-up was completed in 191 patients (90.52%) with a duration of 3-59 (35.5±9.3) months. The mean left ventricular ejection fraction at 3 months after operation was significantly improved, compared to that of the pre-operation (61.0%±7.2% vs 47.1%±5.3%, 0.017). All patients survived, except that one died from brain injury. No major cardiac events occurred, with a cumulative survival rate of 100% at 1 year and 99.53% at 3 year after operation, respectively. It was showed in coronary CT angiography (CTA) examination that all grafts in 132 patients were patent at the mean follow-up duration of (21.5±6.4) months. BRA grafts as arterial conduit in CABG are proved to be safe, easy for total arterial revascularization and have good mid-term clinical results.

摘要

评估双侧桡动脉(BRA)移植用于冠状动脉旁路移植术(CABG)的中期疗效。回顾性分析中国多中心采用BRA移植进行CABG的所有围手术期病历及随访结果。2013年8月至2018年9月期间,共有211例患者(男170例,女41例)接受了BRA导管CABG,平均年龄为(56.5±9.7)岁(年龄范围41至73岁)。其中三血管病变161例,双血管病变50例。90例患者患有糖尿病(DM),35例患有外周血管疾病,4例患有慢性阻塞性肺疾病,11例患有心脏瓣膜病。2例患者接受非体外循环CABG,209例患者接受体外循环CABG并同期行瓣膜手术。共210例患者实现全动脉化血运重建,161例使用左胸廓内动脉导管,移植血管数量为2 - 4根(2.7±0.9)。无手术相关死亡发生,12例患者发生房颤,7例发生血胸,1例发生前臂血肿,13例发生低氧血症,1例发生肺炎。机械通气时间为(8.3±4.7)小时,平均住院时间为(7.1±2.9)天。191例患者(90.52%)完成随访,随访时间为3 - 59(35.5±9.3)个月。术后3个月时平均左心室射血分数较术前显著改善(61.0%±7.2% 对比 47.1%±5.3%,P = 0.017)。除1例因脑损伤死亡外,所有患者均存活。无重大心脏事件发生,术后1年和3年的累积生存率分别为100%和99.53%。冠状动脉CT血管造影(CTA)检查显示,在平均随访时间为(21.5±6.4)个月时,132例患者所有移植血管均通畅。BRA移植作为CABG的动脉导管被证明是安全可行的,易于实现全动脉化血运重建,且具有良好的中期临床疗效。

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