Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
Heart Lung Circ. 2022 Oct;31(10):1399-1407. doi: 10.1016/j.hlc.2022.06.662. Epub 2022 Jul 13.
In coronary artery bypass grafting (CABG) for haemodialysis patients, arteriovenous fistula can reduce blood flow from the internal mammary artery (IMA) graft. The purpose of this study was to delineate the rationale of ipsilateral IMA grafting to the arteriovenous fistula by assessing graft flow and patency.
The clinical records of 139 haemodialysis patients who underwent off-pump CABG, including IMA grafting to the left anterior descending artery (LAD) between April 2007 and December 2018, were retrospectively reviewed. Clinical outcomes and transit-time flowmetry results of IMA to LAD bypass grafts during off-pump CABG and postoperative angiography were examined.
An ipsilateral IMA to the arteriovenous fistula (Ipsi-IMA) was used in 89 patients, and a contralateral IMA to the arteriovenous fistula (Contra-IMA) was used in 50 patients and no hospital deaths occurred. The mean graft flow and angiographic patency rate did not differ between the Ipsi-IMA and Contra-IMA groups. In patients with 51 to 90% stenosis of LAD, there was no significant difference in the mean graft flow. In comparison, in the patients with 91 to 100% stenosis of LAD, the mean graft flow in the Ipsi-IMA group was significantly lower than that in the Contra-IMA group (p=0.03). Kaplan-Meier analyses showed a 5-year survival rate of 57.6% for Ipsi-IMA and 64.8% for Contra-IMA (p=0.47).
In the revascularisation of the LAD, the graft patency rate of the Ipsi-IMA was not inferior to that of the Contra-IMA. However, when the LAD has 91 to 100% stenosis, a Contra-IMA to arteriovenous fistula may be beneficial in terms of sufficient flow capacity.
在为血液透析患者进行冠状动脉旁路移植术（CABG）时，动静脉瘘可能会减少内乳动脉（IMA）移植物的血流。本研究旨在通过评估移植物流量和通畅性来阐述将同侧 IMA 移植物吻合至动静脉瘘的原理。
回顾性分析 2007 年 4 月至 2018 年 12 月期间 139 例行非体外循环 CABG 的血液透析患者的临床记录，其中包括将 IMA 移植物吻合至左前降支（LAD）。检查非体外循环 CABG 期间和术后血管造影时 IMA 至 LAD 旁路移植物的临床结果和瞬时流量测量结果。
89 例患者使用同侧 IMA 至动静脉瘘（Ipsi-IMA），50 例患者使用对侧 IMA 至动静脉瘘（Contra-IMA），无院内死亡。Ipsi-IMA 和 Contra-IMA 组的平均移植物流量和血管造影通畅率无差异。在 LAD 狭窄 51%至 90%的患者中，平均移植物流量无显著差异。相比之下，在 LAD 狭窄 91%至 100%的患者中，Ipsi-IMA 组的平均移植物流量明显低于 Contra-IMA 组（p=0.03）。Kaplan-Meier 分析显示 Ipsi-IMA 组的 5 年生存率为 57.6%，而 Contra-IMA 组为 64.8%（p=0.47）。
在 LAD 血运重建中，Ipsi-IMA 的移植物通畅率不劣于 Contra-IMA。然而，当 LAD 狭窄 91%至 100%时，将 Contra-IMA 吻合至动静脉瘘可能在保证足够的流量能力方面更有利。
