Kim Ji Seong, Kang Yoonjin, Sohn Suk Ho, Hwang Ho Young
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
JTCVS Open. 2022 Jun 11;11:116-126. doi: 10.1016/j.xjon.2022.06.006. eCollection 2022 Sep.
We evaluated the occurrence rate of competitive flow and the fate of grafts of left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis after coronary artery bypass grafting with Y-composite grafts using early and 1-year angiography.
From 2008 to 2017, 923 patients underwent off-pump coronary artery bypass grafting using Y-composite grafting based on the in situ LITA. Early postoperative angiography was performed for all patients. One-year angiography (mean, 13.2 ± 3.1 months) was performed for 86.7% (800 of 923) of patients.
The early occlusion rate of LITA with Y-composite graft (CompLITA) to LAD was 0.7%. Among 917 patent CompLITA-LAD grafts, competitive flow was observed in 39 patients (4.3%). Multivariable analysis showed that the degree of LAD stenosis (odds ratio, 0.897; 95% CI, 0.875-0.920; < .001) and 3-vessel disease (odds ratio, 5.632; 95% CI, 1.168-27.155; = .031) were factors associated with the occurrence of competitive flow of CompLITA-LAD grafts. The receiver operating characteristics curve determined that the cutoff degree of LAD stenosis was 82.5% (sensitivity 82.1% and specificity 85.2%). The failure rate of CompLITA-LAD grafts seen on 1-year angiography was 58.3% in patients with competitive flow. Among patients with competitive flow, left main coronary artery disease was a protective factor (odds ratio, 0.055; 95% CI, 0.009-0.337; = .002) against graft failure of the CompLITA-LAD seen on 1-year angiography.
In CompLITA-LAD, the degree of LAD stenosis and combined 3-vessel disease were associated with the occurrence of competitive flow. CompLITA-LAD grafts with early competitive flow showed a high 1-year graft failure rate of 58%.
我们通过早期和1年时的血管造影，评估了使用Y型复合移植物进行冠状动脉旁路移植术后，左内乳动脉（LITA）至左前降支冠状动脉（LAD）吻合口的竞争性血流发生率及移植物的转归情况。
2008年至2017年，923例患者接受了基于原位LITA的非体外循环冠状动脉旁路移植术，使用Y型复合移植物。所有患者均在术后早期进行了血管造影。86.7%（923例中的800例）的患者在术后1年（平均13.2±3.1个月）进行了血管造影。
Y型复合移植物（CompLITA）至LAD的LITA早期闭塞率为0.7%。在917例通畅的CompLITA-LAD移植物中，39例患者（4.3%）观察到竞争性血流。多变量分析显示，LAD狭窄程度（比值比，0.897；95%可信区间，0.875-0.920；P<0.001）和三支血管病变（比值比，5.632；95%可信区间，1.168-27.155；P=0.031）是与CompLITA-LAD移植物竞争性血流发生相关的因素。受试者工作特征曲线确定LAD狭窄的临界程度为82.5%（敏感性82.1%，特异性85.2%）。在1年血管造影中，有竞争性血流的患者中CompLITA-LAD移植物的失败率为58.3%。在有竞争性血流的患者中，左主干冠状动脉疾病是1年血管造影中CompLITA-LAD移植物失败的保护因素（比值比，0.055；95%可信区间，0.009-0.337；P=0.002）。
在CompLITA-LAD中，LAD狭窄程度和合并的三支血管病变与竞争性血流的发生相关。早期出现竞争性血流的CompLITA-LAD移植物1年时的移植物失败率高达58%。
