Janiec Mikael, Dimberg Axel, Lindblom Rickard P F
Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Interdiscip Cardiovasc Thorac Surg. 2023 Apr 3;36(4). doi: 10.1093/icvts/ivad052.
Coronary artery bypass grafting for advanced coronary artery disease is a well-established procedure with excellent long-term results. The issue of saphenous vein graft (SVG) performance and its relation to clinical symptoms and thereby the potential for improvement by using superior grafts are still not fully understood. We aim to estimate the contribution of late SVG failure to the long-term outcome.
A study population operated between 1997 and 2020, with an internal thoracic artery with a single distal anastomosis and 1, 2 or 3 distal SVG anastomoses, was isolated from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry. Data regarding postoperative clinically driven coronary angiography and status of bypass grafts were collected.
The study population consisted of 44 951 patients. Clinically driven angiography occurred in 10.1% (9.5-10.8), 7.9% (7.6-8.3) and 7.1% (6.7-7.5), respectively, of patients within 3 years and 23.6% (22.6-24.5), 20.0% (19.5-20.6) and 17.5% (16.9-18.2), respectively, of patients within 10 years after surgery. Excluding the first 3 postoperative years, no failed SVGs were found in >75%, 60% and 45%, respectively, of cases when an angiography was performed in the first 10 years after surgery.
The results suggest that the risk of symptomatic graft failure due to vein graft disease during the first 10 years after surgery is in the range of 1-2% for every grafted coronary vessel and provide an estimate for the upper limit of the improvements in results that could be achieved by replacing SVGs with superior grafts.
冠状动脉搭桥术治疗晚期冠状动脉疾病是一种成熟的手术，长期效果良好。大隐静脉移植物（SVG）的性能问题及其与临床症状的关系，以及使用更优质移植物改善的可能性仍未完全明确。我们旨在评估晚期SVG失败对长期预后的影响。
从瑞典心脏病循证护理增强与发展网络系统中筛选出1997年至2020年间接受手术的研究人群，这些患者使用了单支远端吻合的胸廓内动脉以及1、2或3支远端SVG吻合。收集术后临床驱动的冠状动脉造影及旁路移植物状态的数据。
研究人群包括44951例患者。术后3年内分别有10.1%（9.5 - 10.8）、7.9%（7.6 - 8.3）和7.1%（6.7 - 7.5）的患者接受了临床驱动的血管造影，术后10年内分别有23.6%（22.6 - 24.5）、20.0%（19.5 - 20.6）和17.5%（16.9 - 18.2）的患者接受了临床驱动的血管造影。排除术后前3年，在术后前10年进行血管造影的病例中，分别有超过75%、60%和45%的病例未发现SVG失败。
结果表明，术后前10年内，每支移植的冠状动脉血管因静脉移植物疾病导致有症状移植物失败的风险在1% - 2%范围内，并为用更优质移植物替代SVG所能实现的结果改善上限提供了一个估计。
