Dai Longsheng, Yu Wenyuan, Li Qin, Gao Mingxin, Gu Chengxiong, Yu Yang
Department of Coronary Heart Disease Surgery Center District 1, Beijing Anzhen Hospital of Capital Medical University, Beijing, China.
J Thorac Dis. 2022 May;14(5):1598-1606. doi: 10.21037/jtd-22-497.
This study sought to compare and evaluate the clinical efficacy and safety of Y-type coronary artery bypass grafting (CABG) and sequential CABG. However, the prognosis and complication rate of the two treatments are different. Therefore, we need to systematically compare the efficacy and safety of the two surgical schemes.
A total of 112 patients who underwent Y-type CABG and 113 patients who underwent sequential CABG were selected from January 2020 to December 2020. The patients undergoing Y-type CABG of the great saphenous vein (SV) were classified as the experimental group, and those undergoing sequential anastomosis were classified as the control group. The intraoperative blood flow at each anastomotic site of the venous sequential CABG, left ventricular ejection fraction (LVEF), and left ventricular diastolic diameter (LVEDD) at the end of 3 months, 6 months, and 1 year after surgery, the incidence rate of major adverse cardiovascular events, and coronary angiography (CAG) after readmissions due to similar symptoms were compared between the 2 groups. The bridging vascular blockage rate was also determined.
There was no significant difference in cardiac function between the 2 groups in the short term, and the incidence of major adverse cardiovascular events in the 2 groups mainly occurred in the middle-postoperative period (1 year after surgery) or later. There was no statistical difference in the intraoperative real-time blood flow measurements at each anastomosis of the venous bridge between the 2 groups. Compared to the control group, the LVEF of the experimental group was significantly increased at the 1-year follow-up point (51.6±5.1 67.6±5.6, P=0.001). During the operation of Y-type coronary artery bypass grafting, the incidence of major adverse cardiovascular events, vascular bridge, and anastomotic blockage were significantly decreased (16 39, P=0.023).
Large SV Y-type CABG can improve postoperative left heart function and reduce the incidence of postoperative adverse events, which may be of great significance for improving the postoperative mid-term survival rate of patients.
本研究旨在比较和评估Y型冠状动脉旁路移植术（CABG）与序贯式CABG的临床疗效和安全性。然而，两种治疗方法的预后和并发症发生率有所不同。因此，我们需要系统地比较两种手术方案的疗效和安全性。
选取2020年1月至2020年12月期间接受Y型CABG的112例患者和接受序贯式CABG的113例患者。将接受大隐静脉（SV）Y型CABG的患者分为实验组，接受序贯吻合的患者分为对照组。比较两组患者静脉序贯CABG各吻合部位的术中血流量、术后3个月、6个月和1年时的左心室射血分数（LVEF）、左心室舒张直径（LVEDD）、主要不良心血管事件的发生率以及因类似症状再次入院后的冠状动脉造影（CAG）情况。同时确定桥血管堵塞率。
两组患者短期内心功能无显著差异，两组主要不良心血管事件的发生率主要发生在术后中期（术后1年）或更晚。两组静脉桥各吻合口术中实时血流量测量无统计学差异。与对照组相比，实验组在1年随访时LVEF显著升高（51.6±5.1对67.6±5.6，P = 0.001）。在Y型冠状动脉旁路移植术操作过程中，主要不良心血管事件、血管桥和吻合口堵塞的发生率显著降低（16对39，P = 0.023）。
大隐静脉Y型CABG可改善术后左心功能，降低术后不良事件的发生率，这可能对提高患者术后中期生存率具有重要意义。
