Kay P H, Brooks N, Magee P, Sturridge M F, Walesby R K, Wright J E
Br Heart J. 1985 Nov;54(5):489-94. doi: 10.1136/hrt.54.5.489.
Between January 1979 and December 1981, 142 patients undergoing surgery to the right coronary artery agreed to have repeat coronary arteriography one year later. Thirty patients underwent combined endarterectomy and bypass grafting to the right coronary artery. The patency of these grafts was compared with that of grafts in 69 patients undergoing direct grafting to the right coronary artery and in 43 with grafting to the posterior descending coronary artery. There were two hospital deaths and one late death. No patients developed new inferior Q waves on the electrocardiogram. Repeat coronary arteriography at one year showed that 21 (72%) of the 29 grafts were patent after combined endarterectomy and bypass grafting to the right coronary artery. Sixty three (94%) grafts to the right coronary artery and 40 (93%) grafts to the posterior descending coronary artery were patent at one year. Direct grafts to the right coronary artery or its posterior descending branch had a significantly higher patency rate at one year than grafts to the endarterectomised right coronary artery. Graft patency after the combined procedure correlated with the extent of atherosclerosis in the posterior descending coronary artery. It was not influenced by treatment with platelet antagonists. Endarterectomy of the right coronary artery was most successful when it allowed a single graft to perfuse both the large posterior descending and left ventricular branches.
1979年1月至1981年12月期间，142例行右冠状动脉手术的患者同意在一年后接受重复冠状动脉造影。30例患者接受了右冠状动脉内膜切除术和搭桥术联合手术。将这些移植血管的通畅情况与69例直接行右冠状动脉搭桥术患者及43例下行冠状动脉搭桥术患者的移植血管通畅情况进行比较。有2例医院死亡和1例晚期死亡。没有患者心电图出现新的下壁Q波。一年后的重复冠状动脉造影显示，29例右冠状动脉内膜切除术和搭桥术联合手术的移植血管中有21例（72%）通畅。63例（94%）右冠状动脉搭桥术和40例（93%）下行冠状动脉搭桥术的移植血管在一年时通畅。直接行右冠状动脉或其下行分支搭桥术的移植血管一年时的通畅率明显高于行内膜切除术后右冠状动脉搭桥术的移植血管。联合手术后移植血管的通畅与下行冠状动脉粥样硬化的程度相关。它不受血小板拮抗剂治疗的影响。当右冠状动脉内膜切除术能使单一移植血管灌注大的下行冠状动脉和左心室分支时最为成功。
