Ua-Anusorn Karanrat, Tocharoenchok Teerapong, Subtaweesin Thaworn
Division of Cardiovascular Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Asian Cardiovasc Thorac Ann. 2020 Oct;28(8):470-475. doi: 10.1177/0218492320944748. Epub 2020 Jul 16.
Recent studies have revealed that radial artery grafts have excellent patency rates. However, harvesting of the radial artery is generally limited to the non-dominant forearm. We would like to demonstrate the effectiveness and safety of bilateral radial artery harvesting.
We enrolled 173 patients undergoing coronary artery bypass. Bilateral RA were used in 64 cases and unilateral in 109. The primary endpoint was post-harvest forearm and hand complications.
Forearm and hand complications occurred immediately postoperatively in 28.1% of the bilateral radial artery group, significantly more than in the unilateral radial artery group (8.3%). During follow-up, no overall difference was found in post-harvest forearm and hand complications. However, the forearm and hand perception score in the bilateral radial artery group was higher: 8.78 ± 1.45 vs. 8.35 ± 0.84 in the unilateral radial artery group. Subgroup analysis in the bilateral radial artery group revealed no significant difference in forearm and hand perception score between the dominant and non-dominant donor forearms (8.78 ± 1.45 in non-dominant and 8.66 ± 1.00 in dominant forearms). The bilateral radial artery group had more arterial coronary anastomoses, longer operative times, and longer cardiopulmonary bypass times. However, a backward multiple linear regression model revealed that only two factors related to operative time, these were the number of arterial distal coronary anastomosis and cardiopulmonary bypass time.
This study demonstrated that bilateral radial artery conduits can be used effectively and safely with no difference in persistent complications related to the hands and forearms.
最近的研究表明，桡动脉移植血管具有出色的通畅率。然而，桡动脉的获取通常限于非优势前臂。我们想要证明双侧桡动脉获取的有效性和安全性。
我们纳入了173例接受冠状动脉搭桥术的患者。64例使用双侧桡动脉，109例使用单侧桡动脉。主要终点是获取桡动脉后前臂和手部的并发症。
双侧桡动脉组术后立即出现前臂和手部并发症的比例为28.1%，显著高于单侧桡动脉组（8.3%）。在随访期间，获取桡动脉后前臂和手部并发症无总体差异。然而，双侧桡动脉组的前臂和手部感觉评分更高：分别为8.78±1.45和单侧桡动脉组的8.35±0.84。双侧桡动脉组的亚组分析显示，优势和非优势供体前臂之间的前臂和手部感觉评分无显著差异（非优势前臂为8.78±1.45，优势前臂为8.66±1.00）。双侧桡动脉组有更多的冠状动脉吻合、更长的手术时间和更长的体外循环时间。然而，向后多元线性回归模型显示，仅两个因素与手术时间相关，即冠状动脉远端吻合数量和体外循环时间。
本研究表明，双侧桡动脉导管可以有效且安全地使用，与手部和前臂相关的持续性并发症无差异。
