Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Cardiovascular Surgery, Juntendo University School of Medicine Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
Ann Thorac Cardiovasc Surg. 2024;30(1). doi: 10.5761/atcs.oa.24-00029.
To compare the outcomes of left circumflex artery (LCx) revascularization using an internal thoracic artery (ITA) or radial artery (RA) as the second arterial graft.
Patients who underwent primary isolated coronary artery bypass grafting with left anterior descending artery revascularization using an ITA and LCx revascularization using another bilateral ITA (BITA group) or an RA (ITA-RA group) were included. All-cause mortality (primary endpoint), cardiac death, major adverse cardiac events, in-hospital death, and deep sternal wound infection (secondary endpoints) were evaluated.
Among 790 patients (BITA, n = 548 (69%); ITA-RA, n = 242 (31%)), no significant difference in all-cause mortality between the groups was observed (hazard ratio (HR): 0.87; 95% confidence interval (CI): 0.67-1.12; p = 0.27) during follow-up (mean, 10 years). Multivariate analysis revealed that the BITA group exhibited significantly lower rates of long-term all-cause mortality (HR: 0.63; 95% CI: 0.48-0.84; p = 0.01). In the propensity-matched cohort (n = 480, 240 pairs), significantly fewer all-cause deaths occurred in the BITA group (HR: 0.66; 95% CI 0.47-0.93; p = 0.02). There were no significant differences in secondary outcomes.
When used as second grafts for LCx revascularization, ITA grafts may surpass RA grafts in reducing all-cause mortality 10 years postoperatively.
比较使用内乳动脉（ITA）或桡动脉（RA）作为第二动脉移植物进行左回旋支（LCx）血运重建的结果。
纳入接受了单纯冠状动脉旁路移植术，其中前降支采用ITA 进行血运重建，回旋支采用另一个双侧 ITA（BITA 组）或 RA（ITA-RA 组）进行血运重建的患者。评估全因死亡率（主要终点）、心脏性死亡、主要不良心脏事件、住院期间死亡和深部胸骨伤口感染（次要终点）。
在 790 例患者中（BITA 组，n = 548（69%）；ITA-RA 组，n = 242（31%）），两组之间在随访期间（平均 10 年）的全因死亡率无显著差异（风险比（HR）：0.87；95%置信区间（CI）：0.67-1.12；p = 0.27）。多变量分析显示，BITA 组的长期全因死亡率显著降低（HR：0.63；95%CI：0.48-0.84；p = 0.01）。在倾向评分匹配队列中（n = 480，240 对），BITA 组的全因死亡人数显著减少（HR：0.66；95%CI 0.47-0.93；p = 0.02）。次要结局无显著差异。
当用作 LCx 血运重建的第二支移植物时，ITA 移植物可能在术后 10 年内降低全因死亡率。
