Weinschelbaum E E, Gabe E D, Macchia A, Smimmo R, Suárez L D
Department of Cardiovascular Surgery, Favaloro Foundation, Buenos Aires, Argentina.
J Thorac Cardiovasc Surg. 1997 Dec;114(6):911-6. doi: 10.1016/S0022-5223(97)70004-7.
We prospectively tested the feasibility of achieving total arterial revascularization with the use of the radial artery to revascularize the circumflex, diagonal, and right coronary arteries combined with a left internal thoracic artery graft to the left anterior descending artery and, in some cases, a right internal thoracic artery graft to the right coronary artery.
In 164 patients, the radial artery was used as a free Y or T graft from the left internal thoracic artery. Of 568 grafts (3.5 +/- 1 [standard deviation] per patient), 296 (1.8 +/- 0.8 per patient) were constructed with the radial artery as single grafts or as double, triple, or quadruple sequential anastomoses to the circumflex, diagonal, and posterior descending arteries. Diltiazem was administered to prevent spasm. Forty-six patients underwent coronary angiography before discharge from the hospital. Follow-up time was 1 to 19 (9.5 +/- 6.1) months.
Total arterial revascularization was achieved in 137 patients (83.5%). Three (1.8%) died postoperatively of sepsis, ventricular fibrillation, and heart failure, respectively. Three (1.8%) had postoperative myocardial infarction. No hand ischemia occurred. Angiography showed patency of all arterial conduits. Radial artery spasm appeared in 3 (6.5%) of 46 angiograms. Two patients (1.2%) died during the follow-up period of pneumonia and gastrointestinal tract bleeding, respectively. No other events or reoperations occurred, and 95.1% of the patients are free of symptoms.
The radial artery, as a free Y or T graft from the left internal thoracic artery to the circumflex, diagonal, and right coronary arteries, permits total arterial revascularization with excellent patency rates, minimal morbidity and mortality, and no need for reoperation. Longer follow-up times are necessary to draw definitive conclusions.
我们前瞻性地测试了使用桡动脉对回旋支、对角支和右冠状动脉进行血运重建，同时将左乳内动脉移植至左前降支，在某些情况下将右乳内动脉移植至右冠状动脉，以实现完全动脉化血运重建的可行性。
在164例患者中，桡动脉被用作从左乳内动脉游离出的Y形或T形移植物。在568个移植物中（每位患者3.5±1[标准差]个），296个（每位患者1.8±0.8个）是以桡动脉作为单支移植物，或作为与回旋支、对角支和后降支的双支、三支或四支序贯吻合移植物构建的。给予地尔硫䓬以预防痉挛。46例患者在出院前接受了冠状动脉造影。随访时间为1至19（9.5±6.1）个月。
137例患者（83.5%）实现了完全动脉化血运重建。3例（1.8%）分别因败血症、心室颤动和心力衰竭术后死亡。3例（1.8%）发生术后心肌梗死。未发生手部缺血。血管造影显示所有动脉移植物通畅。46例血管造影中有3例（6.5%）出现桡动脉痉挛。2例患者（1.2%）分别在随访期间死于肺炎和胃肠道出血。未发生其他事件或再次手术，95.1%的患者无症状。
桡动脉作为从左乳内动脉至回旋支、对角支和右冠状动脉的游离Y形或T形移植物，可实现完全动脉化血运重建，通畅率极佳，发病率和死亡率极低，且无需再次手术。需要更长的随访时间才能得出明确结论。
