Gurevitch J, Miller H I, Shapira I, Kramer A, Paz Y, Matsa M, Mohr R, Yakirevich V
Department of Thoracic and Cardiovascular Surgery, Ichilov Hospital, Elias Sourasky Tel-Aviv Medical Center, Tel-Aviv University, Israel.
Ann Thorac Surg. 1997 Feb;63(2):382-7. doi: 10.1016/s0003-4975(96)00923-x.
Composite arterial grafting for myocardial revascularization is a surgical technique in which free arterial conduits are proximally attached to an in situ internal mammary artery.
Composite arterial grafting was performed in 78 patients with internal mammary artery (n = 24), inferior epigastric artery (n = 21), or radial artery (n = 33) connected to the internal mammary artery. Overall, 254 distal anastomoses were performed (average number, 3.3 per patient), 225 of which were arterial. All patients were treated postoperatively with high-dose isosorbide dinitrate (4 to 20 mg/h for 24 hours).
The in-hospital mortality rate was 2.6% (2 patients). Early recatheterization studies performed 3 weeks (range, 1 to 20 weeks) after operation in 30 patients demonstrated patency rates of 100%, 93%, and 100% for the composite internal mammary artery, inferior epigastric artery, and radial artery groups, respectively. In addition, two inferior epigastric artery conduits had major intraluminal constriction. At a mean follow-up of 20 months (range, 1 to 42 months) all patients are alive, and all but 2 in the inferior epigastric group (97%) are angina free.
This surgical technique can be safely used. On the basis of our experience, the right internal mammary artery and the radial artery are the most suitable conduits for this procedure. High-dose nitrates given perioperatively prevent spasm and ensure early patency rates.
用于心肌血运重建的复合动脉移植术是一种外科技术，即游离动脉移植物近端与原位胸廓内动脉相连。
对78例患者实施复合动脉移植术，其中胸廓内动脉（n = 24）、腹壁下动脉（n = 21）或桡动脉（n = 33）与胸廓内动脉相连。总共进行了254次远端吻合（平均每位患者3.3次），其中225次为动脉吻合。所有患者术后均接受高剂量硝酸异山梨酯治疗（4至20毫克/小时，持续24小时）。
住院死亡率为2.6%（2例患者）。30例患者在术后3周（范围为1至20周）进行的早期再导管检查显示，复合胸廓内动脉组、腹壁下动脉组和桡动脉组的通畅率分别为100%、93%和100%。此外，两根腹壁下动脉移植物出现严重管腔内狭窄。平均随访20个月（范围为1至42个月）时，所有患者均存活，除腹壁下动脉组的2例患者外（97%），其余患者均无心绞痛。
这种外科技术可以安全使用。根据我们的经验，右侧胸廓内动脉和桡动脉是该手术最适合的移植物。围手术期给予高剂量硝酸盐可预防痉挛并确保早期通畅率。
