Katsavrias Konstantinos, Prapas Sotirios, Calafiore Antonio M, Taggart David, Angouras Dimitrios, Iliopoulos Dimitrios, Di Mauro Michele, Papandreopoulos Styliani, Zografos Panayiotis, Dougenis Dimitrios
1st Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece.
Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
Front Cardiovasc Med. 2024 Oct 18;11:1478166. doi: 10.3389/fcvm.2024.1478166. eCollection 2024.
Since 2000, we have been grafting the right coronary artery system (RCAs) using the proximal portion of the right internal thoracic artery (RITA) as the inflow of the saphenous vein graft (SVG) to increase the number of patients undergoing beating heart complete myocardial revascularization.
From 2000 to 2022, 928 consecutive patients underwent SVG on the RCAs. In 546 patients (58.8%), the inflow was the RITA (I-graft group), and in 382 patients (41.2%), the inflow was the aorta (Ao-graft group). The inclusion criteria were age ≤75 years, ejection fraction >35%, only one SVG per patient, bilateral internal thoracic arteries as a Y-graft on the left system (three-vessel disease, = 817, 88.0%) or left internal thoracic artery on the left anterior descending artery and RITA + SVG on the RCAs (two-vessel disease, = 111, 12.0%). Propensity matching identified 306 patients per group. After a median follow-up of 8 (5-10) years, graft patency was assessed by coronary computed tomographic angiography in 132 patients (64 in the I-graft group and 68 in the Ao-graft group).
Early results were similar in both groups. The I-graft group had higher 10-year survival and freedom from main adverse cardiac events (90.0 ± 2.0 vs. 80.6 ± 3.8, = 0.0162, and 81.3 ± 2.7 vs. 64.7 ± 5.6, = 0.0206, respectively). When RITA was the inflow, SVG had a higher estimated 10-year patency rate (82.8% ± 6.5 vs. 58.8% ± 7.4, = 0.0026) and a smaller inner lumen diameter (2.7 ± 0.4 vs. 3.4 ± 0.6 mm, < 0.0001).
When the inflow is the RITA, SVG grafted to the RCAs (I-graft) may result in a higher patency rate and better outcome than when the inflow is the ascending aorta (Ao-graft). The continuous supply of nitric oxide by RITA may be the cause of the higher patency rate of the I-graft, which can behave like an arterial conduit.
自2000年以来，我们一直使用右胸廓内动脉（RITA）近端作为大隐静脉移植物（SVG）的流入道来移植右冠状动脉系统（RCA），以增加接受心脏不停跳完全心肌血运重建的患者数量。
2000年至2022年，928例连续患者接受了RCA的SVG移植。546例患者（58.8%）的流入道为RITA（I移植组），382例患者（41.2%）的流入道为主动脉（Ao移植组）。纳入标准为年龄≤75岁，射血分数>35%，每位患者仅进行一次SVG移植，双侧胸廓内动脉作为左侧系统的Y形移植物（三支血管病变，n = 817，88.0%）或左前降支上的左胸廓内动脉以及RCA上的RITA + SVG（两支血管病变，n = 111，12.0%）。倾向评分匹配每组确定306例患者。中位随访8（5 - 10）年后，通过冠状动脉计算机断层扫描血管造影术对132例患者（I移植组64例，Ao移植组68例）的移植物通畅情况进行评估。
两组早期结果相似。I移植组10年生存率和无主要不良心脏事件发生率更高（分别为90.0±2.0 vs. 80.6±3.8，P = 0.0162；81.3±2.7 vs. 64.7±5.6，P = 0.0206）。当流入道为RITA时，SVG估计的10年通畅率更高（82.8%±6.5 vs. 58.8%±7.4，P = 0.0026），且内腔直径更小（2.7±0.4 vs. 3.4±0.6 mm，P < 0.0001）。
当流入道为RITA时，移植到RCA的SVG（I移植）可能比流入道为升主动脉（Ao移植）时具有更高的通畅率和更好的结局。RITA持续供应一氧化氮可能是I移植通畅率更高的原因，其表现类似于动脉导管。
