Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
J Cardiothorac Surg. 2023 Oct 7;18(1):273. doi: 10.1186/s13019-023-02384-1.
Coronary events and disease recurrence following coronary artery bypass (CABG) surgery could derive from either failure in the internal thoracic artery (ITA) graft, failure in other conduits or progressive disease in the coronaries. We aim to estimate the contribution of ITA graft failure to the recurrence of symptoms after CABG surgery.
Within the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry, we identified patients who had coronary artery bypass grafting from 1997 to 2020 with a single-vessel ITA graft bypass. Deaths, postoperative incidence of coronary angiography and the presence of a failed graft at the time of the angiography were recorded.
The study population consisted of 1939 patients with a mean follow-up time (SD) of 17.2 (5.6) years. The cumulative incidence (95% CI) at 20 years for a first clinically-driven postoperative angiography was 38.6% (36.2-41.1). A failed ITA graft was reported in 16.4% of the angiographies.
A substantial part of recurrent symptoms of coronary artery disease do not seem to be related to ITA failure. Disease progression in the native coronary vessels may instead be the main driver of symptom recurrence.
冠状动脉旁路移植术（CABG）后发生的冠状动脉事件和疾病复发可能源于内乳动脉（ITA）移植物失败、其他移植物失败或冠状动脉进行性疾病。我们旨在评估 ITA 移植物失败对 CABG 术后症状复发的影响。
在瑞典心脏病推荐治疗评估网络系统（Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry）中，我们确定了 1997 年至 2020 年接受单支 ITA 移植物旁路的 CABG 患者。记录了死亡、术后冠状动脉造影的发生率以及在进行造影时是否存在移植物失败。
研究人群包括 1939 例患者，平均随访时间（SD）为 17.2（5.6）年。20 年时首次临床驱动的术后血管造影的累积发生率（95%CI）为 38.6%（36.2-41.1）。在 16.4%的血管造影中报告了 ITA 移植物失败。
冠状动脉疾病的复发性症状似乎并非都与 ITA 失败有关。相反，原生冠状动脉的疾病进展可能是症状复发的主要驱动因素。
