Bergsma T M, Grandjean J G, Voors A A, Boonstra P W, den Heyer P, Ebels T
Thoraxcenter, University Hospital Groningen, The Netherlands.
Circulation. 1998 Jun 23;97(24):2402-5. doi: 10.1161/01.cir.97.24.2402.
In the past 10 years, there has been a trend to use more arterial grafts instead of vein grafts for coronary artery bypass graft surgery. Although there are many reports on the short- and mid-term follow-up of patients who underwent arterial revascularization with 1 or 2 arteries, little has been reported on the follow-up of patients with 3-vessel disease who received 3 arteries.
We reviewed a group of 256 patients with 3-vessel disease who received the right gastroepiploic artery together with both internal thoracic arteries (ITAs). Vein grafts were not used in these patients. The patients were monitored for up to 7 years (mean, 51+/-15 months). Seven-year actuarial survival was 91.1%. The cumulative probability of event-free survival for myocardial infarction, reintervention, and angina pectoris at 7 years was 97.3%, 95.4%, and 85.4%, respectively.
We conclude that concomitant use of the gastroepiploic artery with both ITAs results in low mortality and a low incidence of myocardial infarction and reintervention at follow-up. Most interestingly, we found 85.4% freedom from angina pectoris after 7 years, which is considerably lower than the results of studies in which vein grafts, single ITA grafts, or double ITA grafts are used. These results strongly support the use of both ITAs and the right gastroepiploic artery for bypass grafting in patients with 3-vessel disease.
在过去10年中，冠状动脉旁路移植手术中使用动脉移植物而非静脉移植物的趋势有所增加。尽管有许多关于接受1条或2条动脉进行动脉血运重建患者的短期和中期随访报告，但对于接受3条动脉的三支血管疾病患者的随访报道较少。
我们回顾了一组256例三支血管疾病患者，他们接受了胃网膜右动脉和双侧胸廓内动脉（ITA）。这些患者未使用静脉移植物。对患者进行了长达7年的监测（平均51±15个月）。7年精算生存率为91.1%。7年时心肌梗死、再次干预和心绞痛无事件生存的累积概率分别为97.3%、95.4%和85.4%。
我们得出结论，胃网膜右动脉与双侧ITA联合使用可导致随访时低死亡率以及心肌梗死和再次干预的低发生率。最有趣的是，我们发现7年后85.4%的患者无心绞痛，这大大低于使用静脉移植物、单支ITA移植物或双支ITA移植物的研究结果。这些结果有力地支持了在三支血管疾病患者中使用双侧ITA和胃网膜右动脉进行旁路移植。
