Kitamura S, Seki T, Kawachi K, Morita R, Kawata T, Mizuguchi K, Kobayashi S, Fukutomi M, Nishii T, Kobayashi H
Department of Surgery III, Nara Medical College, Japan.
Circulation. 1988 Sep;78(3 Pt 2):I129-39.
Coronary artery bypass grafting in pediatric patients provides a unique opportunity to evaluate the characteristics of graft material. Twelve pediatric patients with severe coronary artery involvement secondary to Kawasaki disease underwent coronary artery bypass grafting with internal mammary artery and autologous saphenous vein grafts. Eleven patients were boys and one was a girl; their ages ranged from 5 to 13 years (mean age +/- SD, 8.7 +/- 3.0 years). These 12 patients had 17 internal mammary artery and 11 autologous saphenous vein grafts with a mean value of 2.3 +/- 0.7 grafts per patient. Five patients underwent bilateral internal mammary artery grafting with or without concomitant autologous saphenous vein grafting. There was no mortality, and all patients are leading almost normal lives, although strenuous exercise is still prohibited for some. Biplanar cineangiography was performed before and 1 month after (early postoperative period) coronary artery bypass grafting in all patients and was repeated more than 1 year after (late postoperative period) bypass in eight patients. Changes in graft diameter and graft length were assessed by computer-assisted graphic analysis of 10 internal mammary artery grafts and of seven saphenous vein grafts between the early and late postoperative periods. Patency rates of saphenous vein grafts and of internal mammary artery grafts were 91% and 100%, respectively, at the early postoperative period (p = NS), and 50% and 100%, respectively, at the late postoperative period (p less than 0.05). In addition to the excellent patency of internal mammary artery grafts in the late postoperative period, an in situ internal mammary artery graft was found to have grown 125% in length with 112% body growth (112% body surface area) (r = 0.88, p less than 0.001) and to have enlarged 149% in diameter when the native coronary stenosis was tight. In contrast, the lengths of saphenous vein grafts either failed to change or were slightly decreased at the late postoperative period (p = NS). Growth potential of the internal mammary artery graft provides a new demonstration of the viability and adaptability of this graft. We conclude that the internal mammary artery graft is a "live" conduit with potential for growth and adaptation. This growth potential may be the most important reason for its excellent long-term patency, which suggests that in situ internal mammary artery grafts are the graft of choice for pediatric coronary artery bypass grafting.
小儿冠状动脉搭桥术为评估移植材料的特性提供了独特的机会。12例因川崎病继发严重冠状动脉受累的小儿患者接受了冠状动脉搭桥术，采用了胸廓内动脉和自体大隐静脉移植。11例为男孩，1例为女孩；年龄范围为5至13岁（平均年龄±标准差，8.7±3.0岁）。这12例患者共进行了17次胸廓内动脉移植和11次自体大隐静脉移植，平均每位患者2.3±0.7次移植。5例患者接受了双侧胸廓内动脉移植，伴或不伴有自体大隐静脉移植。无死亡病例，所有患者几乎都过着正常生活，尽管仍禁止一些患者进行剧烈运动。所有患者在冠状动脉搭桥术前和术后1个月（术后早期）均进行了双平面心血管造影，8例患者在搭桥术后1年以上（术后晚期）重复进行了造影。通过计算机辅助图形分析，评估了术后早期和晚期10例胸廓内动脉移植和7例大隐静脉移植的移植直径和移植长度的变化。术后早期大隐静脉移植和胸廓内动脉移植的通畅率分别为91%和100%（p=无显著性差异），术后晚期分别为50%和100%（p<0.05）。除了胸廓内动脉移植在术后晚期具有出色的通畅率外，还发现原位胸廓内动脉移植在长度上增长了125%，同时身体增长了112%（体表面积112%）（r=0.88，p<0.001），并且当原位冠状动脉狭窄严重时，直径增大了149%。相比之下，大隐静脉移植的长度在术后晚期要么没有变化，要么略有缩短（p=无显著性差异）。胸廓内动脉移植的生长潜力为这种移植的生存能力和适应性提供了新的证据。我们得出结论，胸廓内动脉移植是一种具有生长和适应潜力的“活”管道。这种生长潜力可能是其出色的长期通畅率的最重要原因，这表明原位胸廓内动脉移植是小儿冠状动脉搭桥术的首选移植材料。
