Esposito F, Vitale N, Crescenzi B, Scardone M, de Luca L, Cotrufo M
Institute of Cardiac Surgery, Medical School, Monaldi Hospital, Second University of Naples, Italy.
Tex Heart Inst J. 1994;21(3):193-7.
Over a 14-month period, 28 bovine internal mammary arteries (Bioflow, Bio-Vascular, Inc.; St. Paul, Minnesota, USA) were implanted in 20 patients at our institutions. In 8 patients, the bovine internal mammary artery was used to bypass coronary vessels: in 4 of these patients, coronary artery bypass grafting was performed because of coronary disease (1 type-I aortic dissection); in the other 4 (all with aortic dissection), the modified Bentall technique was used for coronary artery reimplantation. In the remaining 12 patients, the bovine artery was used in vascular surgery: as a graft for lower-extremity occlusive disease (4 patients), arteriovenous fistula (2 patients), and aorticorenal bypass (1 patient); and as a patch to the carotid bifurcation or the common femoral artery in association with endarterectomy (5 patients). The 21 bovine grafts were all 5 mm in diameter; the 7 bovine patches were 4 mm. Of the 8 coronary bypass patients, 2 who underwent coronary artery bypass grafting had acute postoperative myocardial infarctions, and 2 who underwent the modified Bentall technique died in surgery. Follow-up angiography showed complete bovine internal mammary artery graft occlusion in 2 patients; 2 symptom-free patients refused examination. Of the vascular surgery patients, 1 with mild left leg claudication had graft occlusion, shown by angiography, 4 months after surgery. Renal scintigraphy performed in the patient with aorticorenal bypass 4 months after operation showed no blood flow to the kidney. Two patients died for reasons unrelated to bovine mammary artery grafting. The remaining patients are well and free of complications. In view of the high incidence of early occlusion, we do not recommend use of the bovine internal mammary artery graft in coronary surgery. In vascular surgery, the results are more encouraging; however, studies comprising a larger number of patients and longer follow-up are needed to determine whether the use of the bovine internal mammary artery graft can be recommended.
在14个月的时间里，我们机构将28条牛的胸廓内动脉（Bioflow，Bio-Vascular公司；美国明尼苏达州圣保罗）植入了20名患者体内。在8名患者中，牛胸廓内动脉用于冠状动脉搭桥：其中4名患者因冠心病（1例I型主动脉夹层）进行了冠状动脉搭桥术；另外4名患者（均有主动脉夹层）采用改良Bentall技术进行冠状动脉再植。在其余12名患者中，牛动脉用于血管外科手术：作为下肢闭塞性疾病的移植物（4例）、动静脉瘘（2例）和主动脉肾旁路（1例）；以及作为颈动脉分叉或股总动脉的补片用于内膜切除术（5例）。21条牛移植物直径均为5毫米；7块牛补片为4毫米。在8例冠状动脉搭桥患者中，2例行冠状动脉搭桥术的患者术后发生急性心肌梗死，2例行改良Bentall技术的患者在手术中死亡。随访血管造影显示2例患者的牛胸廓内动脉移植物完全闭塞；2例无症状患者拒绝检查。在血管外科手术患者中，1例轻度左腿间歇性跛行患者术后4个月血管造影显示移植物闭塞。主动脉肾旁路手术患者术后4个月进行的肾闪烁显像显示肾脏无血流。2例患者因与牛胸廓内动脉移植无关的原因死亡。其余患者情况良好，无并发症。鉴于早期闭塞的发生率较高，我们不建议在冠状动脉手术中使用牛胸廓内动脉移植物。在血管外科手术中，结果更令人鼓舞；然而，需要更多患者参与且随访时间更长的研究来确定是否可以推荐使用牛胸廓内动脉移植物。
