冠状动脉旁路移植术中静脉移植物的外部支架置入：来自两个中心前瞻性研究的中期结果。
External stenting of vein grafts in coronary artery bypass grating: interim results from a two centers prospective study.
机构信息
Heart Surgery Unit, European Hospital, 700, Via portuense, 00149, Rome, Italy.
Department of Statistics, Saint Camillus International University of Health and Medical Sciences, 8, Via di Sant'Alessandro, 00131, Rome, Italy.
出版信息
J Cardiothorac Surg. 2021 Apr 12;16(1):74. doi: 10.1186/s13019-021-01406-0.
BACKGROUND
previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting.
METHODS
102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts' patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6-12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events.
RESULTS
51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6-12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6-54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack.
CONCLUSIONS
External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates.
TRIAL REGISTRATION
Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).
背景
之前评估冠状动脉旁路移植术（CABG）中使用静脉移植物外部支架的研究仅限于体外循环孤立 CABG 和单一移植技术，每位患者使用一个外部支架。本前瞻性研究的目的是评估在接受体外循环和非体外循环 CABG、单一和序贯移植的异质患者群体中使用外部支架的安全性和短期效果。
方法
两个中心共纳入 102 名接受 CABG 的患者。所有患者均接受左前降支内乳动脉和额外的动脉和/或静脉移植物。每位患者至少使用一个外部支架支撑一条静脉移植物。在术后 6-12 个月的预定时间窗口内，使用 CT 血管造影术评估移植物通畅性和静脉移植物管腔均匀性。所有患者均通过电话随访和/或每 6 个月随访一次，以评估主要心脏和脑血管不良事件。
结果
51 名患者（50%）接受非体外循环 CABG，23 名患者（23%）接受双侧内乳动脉移植。每位患者均采用序贯技术（44%）或单一移植物（56%）进行一条或多条静脉移植物移植。84%的患者对所有静脉移植物进行外部支架置入，16%（n=16）的患者对一条静脉移植物进行支架置入，另一条未进行支架置入。在 6-12 个月时，LIMA、RIMA、外部支架置入的静脉移植物和未支架置入的静脉移植物的通畅率分别为 100%、100%、98%和 87.5%。90%的外部支架置入的静脉移植物管腔均匀，而未支架置入的静脉移植物仅有 37%管腔均匀。所有患者均完成临床随访，平均随访时间为 20 个月（6-54 个月）。随访期间，1 例患者因 LIMA-LAD 移植物闭塞导致心肌梗死，1 例患者发生短暂性脑缺血发作。
结论
在包括体外循环 CABG 和序贯静脉移植物移植的 CABG 中，静脉移植物外部支架置入是可行且安全的，并且早期通畅率可接受。
试验注册
该研究在 ClinicalTrials.gov 注册。NCT01860274（首次发布日期 2013 年 5 月 20 日）。
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