Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Hellenic J Cardiol. 2024 Mar-Apr;76:40-47. doi: 10.1016/j.hjc.2023.07.001. Epub 2023 Jul 16.
Little is known about the graft patency after coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG). This study aimed to investigate the graft patency after CABG + CE.
Eligible patients hospitalized at our center during September 2008 and July 2022 with complete follow-up coronary angiographic data available were retrospectively enrolled. The primary end point was the follow-up graft patency of CE targets. Logistic regression was performed to explore the potential predictors of the CE-targeted graft failure.
A total of 160 patients (age: 59.4 ± 9.3 years, male: 75.6%) were enrolled, and 560 grafts were anastomosed. CE was performed on 166 sites, including LAD (36.1%), right coronary artery (RCA, 48.2%), left circumflex artery (9.6%), and diagonal branches (6.0%). Postoperative myocardial infarction was observed in 7 (4.4%) of the patients. During a median follow-up of 12.1 months, the CE-targeted graft patency was 69.9%. The CE-targeted graft patency rate was much higher among the LAD-CE patients than the non-LAD-CE patients (80.0% vs. 64.2%, P = 0.032) but lower than non-endarterectomized LAD (80.0% vs. 92.9%, P = 0.013). No difference was observed regarding the graft patency between off-pump and on-pump surgery (P = 0.585). In the logistic regression, RCA-CE was associated with an increased risk of graft failure even after multiple adjustments (odds ratio: 2.35, 95% confidence interval: 1.05-5.28, P = 0.028).
CABG + CE might be associated with decreased graft patency, especially in those who received RCA-CE, irrespective of surgical technique or antiplatelet/anticoagulation regimen. A multi-center prospective, possibly randomized study with a larger sample size is warranted.
关于冠状动脉内膜切除术（CE）联合冠状动脉旁路移植术（CABG）后的桥通畅情况知之甚少。本研究旨在探讨 CABG+CE 后的桥通畅情况。
回顾性纳入 2008 年 9 月至 2022 年 7 月在我院住院且有完整随访冠状动脉造影资料的患者。主要终点是 CE 目标的随访桥通畅率。采用 logistic 回归分析探讨 CE 目标桥失败的潜在预测因素。
共纳入 160 例患者（年龄：59.4±9.3 岁，男性：75.6%），吻合 560 个桥。CE 共处理 166 个部位，其中左前降支（LAD）36.1%、右冠状动脉（RCA）48.2%、左回旋支（LCX）9.6%、对角支 6.0%。术后心肌梗死 7 例（4.4%）。中位随访 12.1 个月时，CE 目标桥的通畅率为 69.9%。LAD-CE 患者的 CE 目标桥通畅率明显高于非-LAD-CE 患者（80.0% vs. 64.2%，P=0.032），但低于非内膜切除术的 LAD（80.0% vs. 92.9%，P=0.013）。非体外循环和体外循环手术之间的桥通畅率无差异（P=0.585）。logistic 回归分析显示，即使经过多次调整，RCA-CE 与桥失败风险增加相关（比值比：2.35，95%置信区间：1.05-5.28，P=0.028）。
CABG+CE 可能与桥通畅率降低相关，尤其是 RCA-CE 患者，与手术技术或抗血小板/抗凝方案无关。需要一项更大样本量的多中心前瞻性、可能随机研究。
