Kitamura S, Kameda Y, Seki T, Kawachi K, Endo M, Takeuchi Y, Kawasaki T, Kawashima Y
Department of Surgery III, Nara Medical College, Japan.
J Thorac Cardiovasc Surg. 1994 Mar;107(3):663-73; discussion 673-4.
The long-term outcome of myocardial revascularization by coronary artery bypass grafting in patients with severe coronary obstruction caused by Kawasaki disease is largely unknown. A multicenter follow-up study was performed in 1991. A total of 168 patients with Kawasaki disease (127 male [75.6%] and 41 female patients [24.4%]) who had undergone coronary bypass grafting were enrolled. Obstructive coronary artery disease affected the left main trunk in 11.8%, the right coronary artery in 77.6%, the left anterior descending in 87.6%, and the left circumflex in 25.9%. Old myocardial infarction was noted in 46.0% of the patients. Fifty-four patients (32%, 12.4 +/- 9.8 years) underwent bypass grafting with saphenous vein grafts alone. The remaining 114 patients (68%, 9.8 +/- 7.1 years) received at least one internal thoracic artery graft to the left anterior descending coronary artery. Gastroepiploic artery grafts were used in 12 patients. There were no significant differences between the saphenous vein and internal thoracic artery groups in the mean age at operation (12.4 versus 9.8 years), female ratio (22% versus 25%), the number of patients over 20 years of age (9.3% versus 9.6%), previous history of infarction (51.9% versus 41.2%), impaired left ventricular function (ejection fraction < 0.5) (13.0 versus 11.4%), left main trunk disease (11.1% versus 10.5%), the number of vessels involved (2.2 +/- 0.8 versus 2.0 +/- 0.6 per patient), or the mean number of grafts used (1.7 +/- 0.7 versus 1.7 +/- 0.7 per patient). The operative death rate was also the same in the two groups (1.9% versus 0%), but the late cardiac death rate was significantly higher in the saphenous vein graft group (13.0%) than in the internal thoracic artery group (0.9%) (p < 0.003). Actuarial analysis showed a significantly higher survival in the internal thoracic artery group (98.7% +/- 1.2% versus 81.6% +/- 7.0%, p < 0.05) at 90 months after the operation. Late death was strongly related to the absence of an internal thoracic artery graft (p < 0.003) and to the age at the time of operation (p < 0.05). The actuarial patency rate was significantly higher for arterial grafts (77.1% +/- 1.1%, n = 151) than for vein grafts (46.2% +/- 6.3%, n = 126) 85 months after the operation (p < 0.003). Arterial grafts were used for the non-left anterior descending coronary arteries in only 41 of 155 grafts (26.5%); in contrast, vein grafts were used in 85 of 133 grafts (63.9%) (p < 0.005 to 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
川崎病所致严重冠状动脉阻塞患者行冠状动脉旁路移植术的长期预后情况在很大程度上尚不清楚。1991年开展了一项多中心随访研究。共有168例行冠状动脉旁路移植术的川崎病患者入组（男性127例[75.6%]，女性41例[24.4%]）。阻塞性冠状动脉疾病累及左主干的占11.8%，右冠状动脉的占77.6%，左前降支的占87.6%，左旋支的占25.9%。46.0%的患者有陈旧性心肌梗死。54例患者（32%，年龄12.4±9.8岁）仅接受了大隐静脉移植旁路移植术。其余114例患者（68%，年龄9.8±7.1岁）至少接受了一根胸廓内动脉移植至左前降支冠状动脉。12例患者使用了胃网膜动脉移植。大隐静脉组和胸廓内动脉组在平均手术年龄（12.4岁对9.8岁）、女性比例（22%对25%）、20岁以上患者数量（9.3%对9.6%）、既往梗死史（51.9%对41.2%）、左心室功能受损（射血分数<0.5）（13.0对11.4%）、左主干疾病（11.1%对10.5%）、受累血管数量（每位患者2.2±0.8对2.0±0.6）或平均移植血管使用数量（每位患者1.7±0.7对1.7±0.7）方面均无显著差异。两组的手术死亡率相同（1.9%对0%），但大隐静脉移植组的晚期心脏死亡率（13.0%）显著高于胸廓内动脉组（0.9%）（p<0.003）。精算分析显示，术后90个月时胸廓内动脉组的生存率显著更高（98.7%±1.2%对81.6%±7.0%，p<0.05）。晚期死亡与未使用胸廓内动脉移植（p<0.003）及手术时年龄（p<0.05）密切相关。术后85个月时，动脉移植血管的精算通畅率（77.1%±1.1%，n = 151）显著高于静脉移植血管（46.2%±6.3%，n = 126）（p<0.003）。155根移植血管中仅41根（26.5%）将动脉移植用于非左前降支冠状动脉；相比之下，133根移植血管中有85根（63.9%）使用了静脉移植（p<0.005至0.001）。（摘要截选至400字）
