Joshi Manoj M, Paul Saptarshi, Bhosle Krishnarao N, Nagre Suraj W, Parashi Hrishikesh, Jadhao Manish, Rawekar Kunal, Ravikumar Vignesh, Sawkar Vishal, Selwyn Joshua A
Department of Cardiovascular and Thoracic Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Byculla, 400008, Mumbai, Maharashtra, India.
Department of Cardiovascular and Thoracic Surgery, D Y Patil Medical College, Navi, 400706, Mumbai, Maharashtra, India.
J Saudi Heart Assoc. 2020 Dec 18;33(2):109-116. doi: 10.37616/2212-5043.1245. eCollection 2021.
Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG's.
In the present study, 323 patients underwent either sequential (group A, N = 151 grafts, each graft having two anastomoses each) or individual (group B, N = 344 grafts) saphenous vein CABG, between February 2014 and June 2017. The SVG anastomoses were created on obtuse marginal (OM1/OM2) and posterior descending artery (PDA). The graft patency of the vein grafts as well as the left internal mammary artery were assessed by serial coronary angiograms.
Results were evaluated at 6 months, 1, 2 and 3 years post operatively. Group A showed a higher graft patency at 3 years at 80.8%, and group B, 67.1% (P = 0.002). Also, anastomoses on sequential conduits had overall better patency rates at three years (77.2% vs 67.2%, P = 0.005). The groups showed similar results at one year post operatively.
Sequential bypass grafts were associated with superior mid-term patency compared with individual grafts. These findings suggest the more favourable results of sequential bypass grafting to be attributed to the enhanced flow haemodynamics.
尽管在当代冠状动脉旁路移植术（CABG）实践中，多动脉移植或双侧乳内动脉的使用越来越受到重视，但大隐静脉移植（SVG）仍占所有CABG血管的80%（Park等人，2020年）[1]。在印度，个体和序贯大隐静脉移植技术被随意使用，且尚无比较这两种技术中期通畅率的研究。鉴于印度人的冠状动脉比白种人小，这一点尤为重要。本研究旨在比较体外循环下CABG的通畅率。
在本研究中，2014年2月至2017年6月期间，323例患者接受了序贯（A组，N = 151根移植血管，每根移植血管有两个吻合口）或个体（B组，N = 344根移植血管）大隐静脉CABG。SVG吻合口建立在钝缘支（OM1/OM2）和后降支动脉（PDA）上。通过连续冠状动脉造影评估静脉移植血管以及左乳内动脉的移植血管通畅情况。
在术后6个月、1年、2年和3年对结果进行评估。A组在3年时的移植血管通畅率较高，为80.8%，B组为67.1%（P = 0.002）。此外，序贯血管在3年时的吻合口总体通畅率更高（77.%).2%对67.2%，P = 0.005）。两组在术后1年时结果相似。
与个体移植相比，序贯旁路移植具有更好的中期通畅率。这些发现表明，序贯旁路移植更有利的结果归因于血流动力学的改善。
