Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
J Thorac Cardiovasc Surg. 2021 Nov;162(5):1535-1543.e4. doi: 10.1016/j.jtcvs.2020.01.109. Epub 2020 Apr 8.
We compared 10-year graft patency rates and long-term clinical outcomes after off-pump coronary artery bypass grafting using the saphenous vein composite grafts based on the left internal thoracic artery with those using total arterial composite grafts.
A total of 483 patients who underwent off-pump coronary artery bypass grafting using composite grafts based on the left internal thoracic artery were included. The saphenous vein was used as a second (connected to the left internal thoracic artery; n = 63) or a third (connected to the second arterial graft; n = 40) composite graft in 103 patients (SV group); total arterial composite grafting was performed in 380 patients (ART group). A propensity score-matched analysis was used to match the SV group to the ART group (n = 103 patients in each). The median follow-up duration was 128 (97-139) months.
There were no differences in operative mortality and postoperative complication rates between the 2 matched groups. Propensity score-matched analyses showed no differences in the overall survival and freedom from cardiac death rates between the 2 groups (P = .369 and P = .206, respectively) up to 12 years after surgery. Freedom rates from reintervention and major adverse cardiac and cerebrovascular events were also similar between the 2 matched groups (P = .695 and P = .758, respectively) up to 12 years after surgery. Generalized mixed-effects models showed that the 2 matched groups demonstrated no differences in overall and composite graft patency rates during 10 years after surgery (P = .568 and P = .702, respectively).
The saphenous vein composite grafts were equivalent to arterial composite grafts in terms of 10-year graft patency and long-term clinical outcomes.
我们比较了非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting，OPCAB）中采用左内乳动脉复合移植物的 10 年移植物通畅率和长期临床结果，这些结果与采用全动脉复合移植物的结果进行了比较。
共纳入 483 例接受左内乳动脉复合移植物 OPCAB 的患者。103 例患者（SV 组）中，将隐静脉作为第二（与左内乳动脉相连；n=63）或第三（与第二动脉移植物相连；n=40）复合移植物；380 例患者（ART 组）进行了全动脉复合移植物。采用倾向评分匹配分析将 SV 组与 ART 组进行匹配（每组 103 例）。中位随访时间为 128（97-139）个月。
两组之间在手术死亡率和术后并发症发生率方面无差异。倾向评分匹配分析显示，两组在总体生存率和无心脏死亡生存率方面在术后 12 年内无差异（P=0.369 和 P=0.206）。两组之间在再次干预和主要心脏和脑血管不良事件的发生率之间也相似（P=0.695 和 P=0.758）。在术后 12 年内，广义混合效应模型显示两组在总体和复合移植物通畅率方面无差异（P=0.568 和 P=0.702）。
在 10 年的移植物通畅率和长期临床结果方面，隐静脉复合移植物与动脉复合移植物相当。
