Vouhé P, Grondin C M
Ann Thorac Surg. 1979 Apr;27(4):328-34. doi: 10.1016/s0003-4975(10)63308-5.
Reoperation because of early or late coronary graft failure was performed in 43 patients who were part of a group of 1,985 patients operated on for coronary artery disease and followed for up to 7 years. Considerable variation in the results was noted depending on whether the patients were symptomatic or not before reoperation. Of the symptomatic patients, 85% were asymptomatic late (30 months) after reoperation whereas of those patients reoperated on despite the apparent lack of symptoms, 71.5% remained free from angina later on. Moreover, patency rate was high (94.4% or 17/18 grafts) in the first group and much lower (38.4% or 5/13 grafts) in those reoperated on solely on the basis of an early angiogram showing malfunctioning grafts. Patency rate was higher when the graft was totally replaced (92.3% or 12/13 restudied) rather than repaired simply through interposition of a segment of vein (37.5% or 3/8). It is apparent that results of reoperation in symptomatic patients are identical to those of an initial revascularization. On the other hand, patients who are asymptomatic despite early evidence of malfunctioning grafts should be reoperated on only when optimal angiographic conditions are present, that is, a coronary artery that is a good size, severely narrowed, and supplying a large myocardial area.
在1985例接受冠状动脉疾病手术并随访长达7年的患者中，有43例因早期或晚期冠状动脉移植失败而再次手术。根据再次手术前患者是否有症状，结果存在相当大的差异。有症状的患者中，85%在再次手术后晚期（30个月）无症状，而那些尽管明显无症状但仍接受再次手术的患者中，71.5%后来仍无心绞痛发作。此外，第一组的通畅率很高（94.4%或18条移植血管中的17条），而仅根据早期血管造影显示移植血管功能异常而接受再次手术的患者中，通畅率则低得多（38.4%或13条移植血管中的5条）。当移植血管完全置换时，通畅率更高（92.3%或13条再次检查的移植血管中的12条），而不是仅仅通过插入一段静脉进行修复（37.5%或8条移植血管中的3条）。显然，有症状患者再次手术的结果与初次血运重建的结果相同。另一方面，尽管早期有移植血管功能异常的证据但无症状的患者，只有在具备最佳血管造影条件时才应进行再次手术，即冠状动脉管径合适、严重狭窄且供应大面积心肌区域。
