Shih Beatrice Chia-Hui, Chung Suryeun, Kim Hakju, Chang Hyoung Woo, Kim Dong Jung, Lim Cheong, Park Kay-Hyun, Kim Jun Sung
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Thorac Cardiovasc Surg. 2020 Apr 5;53(2):64-72. doi: 10.5090/kjtcs.2020.53.2.64.
It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization.
Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency.
Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011).
LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA-based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.
人们普遍认为，使用双侧胸廓内动脉（BITA）复合移植物可提高冠状动脉旁路移植术（CABG）后的长期生存率。尽管基于左胸廓内动脉（LITA）的Y形复合移植物被广泛采用，但技术或解剖学上的困难需要复杂的配置。我们旨在研究BITA配置是否会影响接受冠状动脉血运重建患者的生存率或通畅率。
2006年1月至2017年6月期间，1161例患者在首尔国立大学盆唐医院接受了CABG，该医院的标准技术是基于LITA的Y形复合移植物，将右胸廓内动脉（RITA）依次吻合至非左前降支（LAD）靶血管。共有160例患者接受了改良的BITA CABG。回顾性分析他们的病历和影像资料，以研究技术细节、临床结果和移植物通畅情况。
由于RITA长度不足（47%）、使用LITA存在问题（28%）和靶血管解剖结构（25%），对典型Y形移植物（第1组，n=90）、基于LITA的I形移植物（第2组，n=39）和基于RITA的复合移植物（第3组，n=31）进行了改良。30天总死亡率为1.9%。在术后平均29.9±33.1个月接受计算机断层扫描或传统血管造影的116例患者中，LAD、左旋支动脉和右冠状动脉区域移植物的通畅率分别为98.7%、95.3%和83.6%。流入、二级和三级移植物的通畅率分别为98.2%、90.5%和80.4%。基于RITA的移植物（第3组）在各种配置中通畅率最低（p<0.011）。
基于LITA的Y形复合移植物显示出令人满意的临床结果和通畅率，而基于RITA的复合移植物改良后的通畅率和5年生存率最低。因此，在使用基于RITA的复合移植物时，在采用非典型配置之前应考虑其他选择。
