Leonard Jeremy R, Abouarab Ahmed A, Taggart David P, Gaudino Mario F L
Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th St, M-404, New York, NY 10065 USA.
Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
Indian J Thorac Cardiovasc Surg. 2018 Dec;34(Suppl 3):230-233. doi: 10.1007/s12055-018-0693-4. Epub 2018 Aug 3.
Over the past three decades, there have been a plethora of retrospective observational data and meta-analyses which support the hypothesis of improved clinical outcomes using bilateral internal thoracic arteries (BITA) when compared to saphenous vein grafts (SVGs). However, recently published results have brought this thinking into doubt. We discuss the existing literature on the subject and attempt to clarify the appropriate use of BITA in coronary artery bypass surgery (CABG).
A review of all existing meta-analyses on BITA was conducted to better understand the utility of BITA in CABG. A review of the largest randomized controlled trials on the subject was then compared to the observational data.
In all existing meta-analyses, BITA shows a significant advantage over the use of a single internal thoracic artery (SITA) with SVGs. The two largest randomized controlled trials evaluating BITA failed to show a survival advantage and brought into question the complications associated with BITA.
At present, the use of multiple arterial grafts remains a reasonable choice, particularly in young patients, provided that their use does not increase the operative risk. Further evidence currently being collected may lend a definitive answer in the near future.
在过去三十年中，有大量回顾性观察数据和荟萃分析支持与大隐静脉移植物（SVG）相比，使用双侧胸廓内动脉（BITA）可改善临床结局这一假说。然而，最近发表的结果对此观点提出了质疑。我们讨论了关于该主题的现有文献，并试图阐明BITA在冠状动脉旁路移植术（CABG）中的合理应用。
对所有关于BITA的现有荟萃分析进行综述，以更好地了解BITA在CABG中的效用。然后将该主题最大的随机对照试验的综述与观察数据进行比较。
在所有现有荟萃分析中，BITA与使用单根胸廓内动脉（SITA）及SVG相比显示出显著优势。评估BITA的两项最大的随机对照试验未能显示出生存优势，并对与BITA相关的并发症提出了质疑。
目前，使用多根动脉移植物仍然是一个合理的选择，特别是在年轻患者中，前提是其使用不会增加手术风险。目前正在收集的进一步证据可能在不久的将来给出明确答案。
