Li Bo, Li Haiming, Wang Liangshan, Liu Changcheng, Dai Longsheng, Li Qin, Gu Chengxiong
Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Perfusion. 2022 Apr;37(3):266-275. doi: 10.1177/0267659121990571. Epub 2021 Feb 21.
The purpose of this study was to investigate the effect of different anastomotic positions on the early patency of the distal end-to-side anastomosis of sequential saphenous vein grafts (SVG) in off-pump coronary artery bypass grafting (OPCAB).
A total of 259 patients who underwent OPCAB between August 2014 and August 2019 and presented for coronary computed tomography angiography (CCTA) to evaluate graft patency at 1 year post-OPCAB were analyzed. There are two kinds of distal end-to-side anastomosis of SVG, to posterior descending artery (PDA) and main trunk of right coronary artery (RCA). In all, 1044 distal coronary anastomoses on 518 grafts which included 180 left internal mammary artery (LIMA) grafts, individual 79 SVG and 259 sequential SVG were assessed using CCTA. The blood flow (BF), pulsatility index (PI), and patency of every anastomosis were recorded. Besides, comprehensive data of SV-PDA and SV-RCA patients was also compared.
The mean BF of SV-RCA was significantly higher than that of SV-PDA (31.71 ± 18.60 vs 22.62 ± 14.48, = 0.001), and the PI value of SV-RCA was significantly lower than that of SV-PDA (2.57 ± 1.17 vs 3.50 ± 1.69, = 0.001). The patency of RCA system was significantly lower than that of the LAD and the left circumflex system (79.25% vs 90.13%, 90.23% respectively, = 0.001). In sequential SVG, the patency of SV-PDA was significantly lower than that of SV-RCA (74.01% vs 86.59%, = 0.001). Although, there was no significant difference in left ventricular ejective fraction, the left ventricular end-diastolic diameter (LVDd) in SV-PDA group was significantly larger than that in SV-RCA (52.67 ± 8.72 mm vs 47.34 ± 7.55, = 0.001). In addition, the target vessel diameter in SV-PDA group was smaller than that in SV-RCA group (1.52 ± 0.41 mm vs 3.17 ± 0.88 mm, = 0.001).
The early patency of sequential SVG end to RCA after OPCAB is generally superior to that of to PDA, especially for patients with large LVDd.
本研究旨在探讨非体外循环冠状动脉搭桥术（OPCAB）中不同吻合位置对序贯大隐静脉移植血管（SVG）远端端侧吻合口早期通畅率的影响。
分析2014年8月至2019年8月期间接受OPCAB并在术后1年接受冠状动脉计算机断层扫描血管造影（CCTA）以评估移植血管通畅情况的259例患者。SVG远端端侧吻合有两种类型，即与后降支动脉（PDA）和右冠状动脉（RCA）主干吻合。总共对518根移植血管上的1044个冠状动脉远端吻合口进行了评估，其中包括180根左乳内动脉（LIMA）移植血管、79根单根SVG和259根序贯SVG。记录每个吻合口的血流（BF）、搏动指数（PI）和通畅情况。此外，还比较了SV-PDA和SV-RCA患者的综合数据。
SV-RCA的平均BF显著高于SV-PDA（31.71±18.60 vs 22.62±14.48，P = 0.001），且SV-RCA的PI值显著低于SV-PDA（2.57±1.17 vs 3.50±1.69，P = 0.001）。RCA系统的通畅率显著低于左前降支和左旋支系统（分别为79.25% vs 90.13%、90.23%，P = 0.001）。在序贯SVG中，SV-PDA的通畅率显著低于SV-RCA（74.01% vs 86.59%，P = 0.001）。尽管左心室射血分数无显著差异，但SV-PDA组的左心室舒张末期直径（LVDd）显著大于SV-RCA组（52.67±8.72mm vs 47.34±7.55，P = 0.001）。此外，SV-PDA组的靶血管直径小于SV-RCA组（1.52±0.41mm vs 3.17±0.88mm，P = 0.001）。
OPCAB术后序贯SVG与RCA吻合的早期通畅率总体上优于与PDA吻合，尤其是对于LVDd较大的患者。
