Kim Min-Seok, Hwang Seong Wook, Kim Ki-Bong
Cardiovascular Center, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
Cardiovascular Center, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
Semin Thorac Cardiovasc Surg. 2023;35(3):483-492. doi: 10.1053/j.semtcvs.2022.05.004. Epub 2022 May 20.
We assessed the incidence of competitive flow with early postoperative angiograms in patients who received a "no-touch" saphenous vein (NT SV) composite graft and reexamined the status of competitive flow at 1-year. Early postoperative angiograms were performed in 806 patients who underwent myocardial revascularization using a NT SV Y-composite graft based on the in situ left internal thoracic artery (LITA). Competitive conduit flow was observed in 102 distal anastomoses (102 of 3039 [3.4%] anastomoses) of 94 patients (94 of 806 [11.7%]; NT SV competitive flow in 74 and LITA competitive flow in 20). Of the 94 patients, 63 patients (50 with NT SV competition and 13 with LITA competition) were re-evaluated with 1-year postoperative angiograms. Fifty-six competitive NT SV conduits in 50 patients were reevaluated at 1-year postoperatively: 44 (78.6%) early competitive anastomoses had become patent and 12 (21.4%) were occluded. NT SV with pedicle tissue showed a higher tendency of being perfectly patent at 1-year postoperatively than NT SV without pedicle tissue (17 of 40 [42.5%] vs 2 of 16 [12.5%]; P = 0.007). Thirteen competitive LITA conduit anastomoses in 13 patients were reevaluated 1-year postoperatively: 9 (69.2%) early competitive anastomoses had become patent and 4 (30.8%) were occluded. Competitive flow was shown on early postoperative angiograms in 3.4% of distal anastomoses in patients who received NT SV Y-composite grafts. Approximately 80% of the competitive NT SV conduits were patent 1-year postoperatively, and perfect patency rates were higher in patients who had received NT SV with pedicle tissue than in patients who had received NT SV without pedicle tissue.
我们通过早期术后血管造影评估了接受“非接触式”大隐静脉（NT SV）复合移植物患者的竞争性血流发生率，并在1年时重新检查了竞争性血流状态。对806例使用基于原位左乳内动脉（LITA）的NT SV Y型复合移植物进行心肌血运重建的患者进行了早期术后血管造影。在94例患者（806例中的94例[11.7%]）的102个远端吻合口（3039个吻合口中的102个[3.4%]）观察到竞争性管道血流（74例为NT SV竞争性血流，20例为LITA竞争性血流）。在这94例患者中，63例患者（50例有NT SV竞争和13例有LITA竞争）在术后1年进行了血管造影复查。对50例患者的56条竞争性NT SV管道在术后1年进行了重新评估：44条（78.6%）早期竞争性吻合口已通畅，12条（21.4%）闭塞。带蒂组织的NT SV在术后1年完全通畅的趋势高于不带蒂组织的NT SV（40条中的17条[42.5%]对16条中的2条[12.5%]；P = 0.007）。对13例患者的13个竞争性LITA管道吻合口在术后1年进行了重新评估：9个（69.2%）早期竞争性吻合口已通畅，4个（30.8%）闭塞。接受NT SV Y型复合移植物患者的远端吻合口中，3.4%在早期术后血管造影中显示有竞争性血流。术后1年，约80%的竞争性NT SV管道通畅，接受带蒂组织NT SV的患者的完全通畅率高于接受不带蒂组织NT SV的患者。
