Ag-Rejuan Yael, Pevni Dmitry, Nesher Nachum, Kramer Amir, Paz Yosef, Mohr Rephael, Malamud Dorel, Ben-Gal Yanai
Department of Cardiothoracic Surgery, Sourasky Medical Center, Tel Aviv and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Interact Cardiovasc Thorac Surg. 2019 Dec 1;29(6):830-835. doi: 10.1093/icvts/ivz193.
The use of bilateral internal thoracic artery graft for myocardial revascularization has improved the long-term survival and decreased the rate of repeat interventions in patients. A key technical factor for complete arterial revascularization is sufficient length of the internal thoracic artery (ITA) graft. The purpose of this study was to compare early and long-term outcomes of 'standard composite' grafting and 'reverse composite' grafting. In the former, the left ITA (LITA) is connected to the left anterior descending artery, and the right ITA is connected end-to-side to the LITA for revascularization of the left circumflex artery. In 'reverse composite' grafting, the LITA is connected to the left circumflex artery, and the right ITA is connected end-to-side to the LITA, for revascularization of the left anterior descending artery.
We compared the outcomes of 1365 patients who underwent coronary artery bypass grafting in Tel-Aviv Sourasky Medical Centre, using bilateral ITA as standard composite versus 'reverse composite' grafts, between January 1996 and December 2011. A propensity score matching analysis compared 132 pairs of patients who underwent bilateral ITA by the 2 modes.
Twelve hundred and thirty patients underwent standard 'composite' grafts and 135 underwent 'reverse composite' grafts. Early mortality and early adverse effects did not differ significantly between the groups. After matching, the difference in late mortality between the groups was not statistically significant.
This study suggests that revascularization of the left anterior descending with the right ITA, arising from an in situ LITA, is safe and provides early outcomes and long-term survival that are not significantly different from those of the standard composite grafting technique. However, there was evidence of better survival in the standard composite group.
使用双侧胸廓内动脉移植进行心肌血运重建可提高患者的长期生存率并降低再次干预率。胸廓内动脉（ITA）移植足够的长度是实现完全动脉血运重建的关键技术因素。本研究的目的是比较“标准复合”移植和“反向复合”移植的早期和长期结果。在前者中，左胸廓内动脉（LITA）连接至左前降支动脉，右胸廓内动脉与LITA端侧连接以实现左旋支动脉的血运重建。在“反向复合”移植中，LITA连接至左旋支动脉，右胸廓内动脉与LITA端侧连接，以实现左前降支动脉的血运重建。
我们比较了1996年1月至2011年12月在特拉维夫索拉斯基医疗中心接受冠状动脉旁路移植术的1365例患者的结果，这些患者使用双侧ITA作为标准复合移植与“反向复合”移植。倾向评分匹配分析比较了132对通过两种方式接受双侧ITA的患者。
1230例患者接受了标准的“复合”移植，135例接受了“反向复合”移植。两组之间的早期死亡率和早期不良反应无显著差异。匹配后，两组之间的晚期死亡率差异无统计学意义。
本研究表明，由原位LITA发出的右ITA对左前降支进行血运重建是安全的，其早期结果和长期生存率与标准复合移植技术相比无显著差异。然而，有证据表明标准复合组的生存率更高。
