Calafiore A M, Di Giammarco G
Division of Cardiac Surgery, University of Chieti, Italy.
Semin Thorac Cardiovasc Surg. 1996 Jan;8(1):15-23.
A complete revascularization with three or more arterial conduits was achieved, giving the patient, if possible, three blood sources from the in situ arterial grafts (skeletonized bilateral internal thoracic arteries [ITAs] and right gastroepiploic artery). If one of these conduits was not available, a radial artery was used, the proximal anastomosis being constructed on an ITA. The inferior epigastric artery was used if a sequential anastomosis was not advisable or to lengthen another arterial graft. With this strategy, 247 patients underwent surgery from October 1991 through April 1995; 774 arterial conduits were used: 244 left ITAs, 187 right ITAs, 159 right gastroepiploic arteries, 114 radial arteries, and 70 inferior epigastric arteries. The in-hospital and late mortality rates were 1.2% (3 patients) and 1.6% (4 patients), respectively. Of the 240 patients alive, 235 (97.9%) are asymptomatic. We compared the 42-month survival and event-free survival curves of these patients with those of an historical cohort of patients who underwent surgery with mixed (1 left ITA and saphenous vein grafts) revascularization. Whereas the survival rate was similar (97.82% +/- 1.11% vs 99.35% +/- 0.65, P = .174), the event-free survival rate was significantly better in the total arterial group (93.72% +/- 2.1 % vs 85.62% +/- 2.84%, P = .021). We conclude that complete revascularization with three or more arterial conduits is technically feasible with a low mortality rate; the mid-term results allow us to continue this strategy of myocardial revascularization.
采用三根或更多动脉血管进行完全血运重建，如果可能的话，为患者提供来自原位动脉移植物的三个血源（骨骼化双侧胸廓内动脉[ITA]和右胃网膜动脉）。如果这些血管中有一根不可用，则使用桡动脉，近端吻合口构建在ITA上。如果不适合进行序贯吻合或用于延长另一根动脉移植物，则使用腹壁下动脉。采用这种策略，1991年10月至1995年4月期间有247例患者接受了手术；使用了774根动脉血管：244根左ITA、187根右ITA、159根右胃网膜动脉、114根桡动脉和70根腹壁下动脉。住院死亡率和晚期死亡率分别为1.2%（3例患者）和1.6%（4例患者）。在240例存活患者中，235例（97.9%）无症状。我们将这些患者的42个月生存率和无事件生存率曲线与接受混合（1根左ITA和大隐静脉移植物）血运重建手术的历史队列患者的曲线进行了比较。虽然生存率相似（97.82%±1.11%对99.35%±0.65，P = 0.174），但全动脉组的无事件生存率明显更好（93.72%±2.1%对85.62%±2.84%，P = 0.021）。我们得出结论，采用三根或更多动脉血管进行完全血运重建在技术上是可行的，死亡率较低；中期结果使我们能够继续采用这种心肌血运重建策略。
