Wang Maozhou, Jia Songhao, Pu Xin, Sun Lizhong, Gong Ming, Zhang Hongjia
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Interventional Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Oct 26;8:743562. doi: 10.3389/fcvm.2021.743562. eCollection 2021.
Stanford type A aortic dissection (STAAD) is often associated with coronary artery problems requiring coronary artery bypass grafting (CABG). However, the prognosis of different proximal graft locations remains unclear. From May 2015 to April 2020, 62 patients with acute STAAD who underwent aortic surgery concomitant with CABG were enrolled in our study. Aortic bypass was defined as connecting the proximal end of the vein bridge to the artificial aorta (SVG-AO); non-aortic bypass was defined as connecting the proximal end of the vein bridge to a non-aorta vessel, including left subclavian artery, left common carotid artery, and right brachiocephalic artery (non-SVG-AO). We compared early- and mid-term results between patients in the above two groups. Early results included death and bleeding, and mid-term results graft patency, aortic-related events, and bleeding. Grafts were evaluated by post-operative coronary computed tomography angiography. According to the Fitzgibbon classification, grade A (graft stenosis <50%) is considered a patent graft. Univariate and multivariate analyses were performed to assess differences between aortic and non-aortic bypass in STAAD. SVG-AO and non-SVG-AO were performed in 15 and 47 patients, respectively. There was no significant difference in death (log-rank test, = 0.426) or bleeding ( = 0.766) between the two groups in the short term. One year of follow-up was completed in 37 patients (eight in the SVG-AO group and 29 in the non-SVG-AO group), among which 14/15 (93.3%) grafts were patent in the SVG-AO group and 32/33 (97.0%) grafts in the non-SVG-AO at 1 week, without a significant difference ( = 0.532). At 3 months, 12/13 (92.3%) grafts were patent in the SVG-AO group and 16/32 (50.0%) grafts in the non-SVG-AO, with a significant difference ( = 0.015), and 12/13 (92.3%) grafts in the SVG-AO group and 15/32 (46.9%) grafts in the non-SVG-AO group were patents, with a significant difference. Multivariate analysis showed proximal aortic bypass and dual anticoagulation to be protective factors for the 1-year patency of grafts. In patients requiring aortic dissection surgery with concomitant CABG, no differencess' between SVG-AO and SVG-non-AO in early outcomes were detected, but SVG-AO may have higher mid-term patency.
斯坦福A型主动脉夹层（STAAD）常伴有需要冠状动脉旁路移植术（CABG）的冠状动脉问题。然而，不同近端移植位置的预后仍不明确。2015年5月至2020年4月，62例接受主动脉手术并同期行CABG的急性STAAD患者纳入本研究。主动脉旁路定义为将静脉桥近端与人工主动脉相连（SVG-AO）；非主动脉旁路定义为将静脉桥近端与非主动脉血管相连，包括左锁骨下动脉、左颈总动脉和右头臂动脉（非SVG-AO）。我们比较了上述两组患者的早期和中期结果。早期结果包括死亡和出血，中期结果包括移植物通畅情况、主动脉相关事件和出血。通过术后冠状动脉计算机断层扫描血管造影评估移植物。根据菲茨吉本分类，A级（移植物狭窄<50%）被认为是通畅的移植物。进行单因素和多因素分析以评估STAAD中主动脉旁路和非主动脉旁路之间的差异。SVG-AO和非SVG-AO分别应用于15例和47例患者。短期内两组患者的死亡（对数秩检验，P = 0.426）或出血（P = 0.766）无显著差异。37例患者完成了1年随访（SVG-AO组8例，非SVG-AO组29例），其中SVG-AO组14/15（93.3%）的移植物在1周时通畅，非SVG-AO组32/33（97.0%）的移植物通畅，无显著差异（P = 0.532）。3个月时，SVG-AO组12/13（92.3%）的移植物通畅，非SVG-AO组16/32（50.0%）的移植物通畅，有显著差异（P = 0.015），SVG-AO组12/13（92.3%）的移植物和非SVG-AO组15/32（46.9%）的移植物通畅，有显著差异。多因素分析显示近端主动脉旁路和双重抗凝是移植物1年通畅的保护因素。在需要进行主动脉夹层手术并同期行CABG的患者中，未检测到SVG-AO和非SVG-AO在早期结果上的差异，但SVG-AO可能具有更高的中期通畅率。
