冠状动脉重建术中双侧桡动脉移植：261例患者的技术及早期结果

Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients.

作者信息

Tatoulis J, Buxton B F, Fuller J A

机构信息

Department of Cardiac Surgery, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.

出版信息

Ann Thorac Surg. 1998 Sep;66(3):714-19; discussion 720. doi: 10.1016/s0003-4975(98)00668-7.

DOI:10.1016/s0003-4975(98)00668-7

PMID:9768920

Abstract

BACKGROUND

To achieve arterial myocardial revascularization we have progressively used more single and bilateral internal thoracic artery and radial artery (RA) grafts. We evaluated our early experience with bilateral radial artery to coronary grafts.

METHODS

As part of their coronary reconstruction, 261 patients had 522 bilateral RA grafts from March 1995 to June 1997. Mean age was 61.1 years. There were 70 (27%) patients with non-insulin-dependent diabetes and 13 (5%) with insulin-dependent diabetes. Unstable angina was seen in 54 (21%) patients. Left ventricular ejection fraction less than 50% was noted in 74 (28.4%) patients. Coronary revascularization was completed with additional single internal thoracic artery in 229 patients (88%), bilateral internal thoracic artery in 25 patients (9.6%), and vein grafts in 13 patients (5%). Intraluminal 1% papaverine in blood was used. There were 3.6 +/- 0.7 distal anastomoses per patient, with a total of 939, 921 (98%) with arterial conduits and 18 with vein grafts. Five hundred ninety-four (63%) of the anastomoses were with RAs. Of the 522 RA grafts 72 (13.8%) were used sequentially. The RA was most frequently placed to the circumflex marginals (261 patients, 100%) and posterior descending (169 patients, 65%). Proximal RA anastomosis was directly to the aorta in 472 patients, the internal thoracic artery in 42, or another RA in 8. All anastomoses were constructed during a single cross-clamp period (mean, 74.2 +/- 26.6 minutes).

RESULTS

Operative mortality was 2 patients (0.8%). Complications included stroke in 2 patients (0.8%), deep internal infection in 2 (0.8%), reoperation for hemorrhage in 1 (0.4%), and myocardial infarction in 2 (0.8%). Mean peak creatine kinase-MB was 13.2 +/- 11.6 IU/L. There were no forearm infections or hand ischemia, but there were 4 (1.6%) hematomas, 1 requiring drainage. Angiography was done on 16 patients with RA grafts, a mean of 4.2 months postoperatively. Twenty of 22 distal anastomoses were patent (91%), and there was 1 occlusion and 1 string sign.

CONCLUSIONS

Bilateral RA to coronary grafting extends the scope of arterial myocardial revascularization, and is safe. Late angiographic results are required.

摘要

背景

为实现动脉性心肌血运重建，我们逐渐增加了单支和双侧胸廓内动脉及桡动脉（RA）移植物的使用。我们评估了双侧桡动脉至冠状动脉移植物的早期经验。

方法

作为冠状动脉重建的一部分，1995年3月至1997年6月期间，261例患者接受了522支双侧RA移植物。平均年龄为61.1岁。有70例（27%）非胰岛素依赖型糖尿病患者和13例（5%）胰岛素依赖型糖尿病患者。54例（21%）患者有不稳定型心绞痛。74例（28.4%）患者左心室射血分数低于50%。229例患者（88%）通过额外的单支胸廓内动脉完成冠状动脉血运重建，25例患者（9.6%）通过双侧胸廓内动脉，13例患者（5%）通过静脉移植物。使用含1%罂粟碱的血液。每位患者平均有3.6±0.7个远端吻合口，共939个，其中921个（98%）使用动脉管道，18个使用静脉移植物。594个（63%）吻合口使用的是RA。在522支RA移植物中，72支（13.8%）是序贯使用的。RA最常置于回旋支边缘支（261例患者，100%）和后降支（169例患者，65%）。472例患者近端RA吻合直接与主动脉进行，42例与胸廓内动脉进行，8例与另一支RA进行。所有吻合均在单次阻断主动脉期间完成（平均74.2±26.6分钟）。

结果

手术死亡率为2例（0.8%）。并发症包括2例（0.8%）中风、2例（0.8%）深部感染、1例（0.4%）因出血再次手术以及2例（0.8%）心肌梗死。肌酸激酶同工酶峰值平均为13.2±11.6 IU/L。没有前臂感染或手部缺血，但有4例（1.6%）血肿，1例需要引流。对16例接受RA移植物的患者进行了血管造影，平均在术后4.2个月。22个远端吻合口中20个通畅（91%），有1个闭塞和1个串珠征。