使用左乳内动脉复合 T 型移植进行心肌血管重建手术--大隐静脉与桡动脉的比较

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-09-01 Epub Date: 2023-07-28 DOI:10.1055/s-0043-1771358
Arne Eide, Jill Jussli-Melchers, Christine Friedrich, Assad Haneya, Georg Lutter, Jochen Cremer, Jan Schoettler
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引用次数: 0

摘要

背景:左乳内动脉(LIMA)和桡动脉(RA)之间的复合 T 型移植物是完全动脉心肌血运重建的常见概念。本研究旨在探讨在这种情况下使用大隐静脉(SV)代替 RA 是否会带来相当好的疗效:方法:纳入2014年初至2019年底期间在基尔校区石勒苏益格-荷尔斯泰因大学医院心血管外科使用RA或一段SV至右冠状动脉或环状动脉进行T移植的心肌血管重建术患者。为尽量减少手术差异,只有一名资深外科医生对患者进行了观察。排除标准包括既往接受过心脏手术、术前体外循环支持、非泵手术、额外的主动脉冠状动脉搭桥术和心脏联合手术:共有 115 名患者接受了研究。55例患者的T型血管移植物被置于LIMA和SV之间,60例患者的T型血管移植物被置于LIMA和RA之间。SV 组患者年龄较大(70.6 ± 7.8 岁 vs. 58.5 ± 10.0 岁;P = 0.027)、动脉高血压(83.6% vs. 61.7%;P = 0.009)和心房颤动(18.2% vs. 1.7%;P = 0.003)。他们较少主动吸烟(16.4% 对 38.3%;P = 0.009),较少有静脉曲张手术史(0 对 15.0%;P = 0.003)。大隐静脉组的升主动脉钙化发生率也更高(18.2% 对 3.3%,P = 0.009)。两组的手术时间和远端吻合次数没有显著差异。静脉患者术后谵妄的发生率更高(16.7% 对 5.0%;P = 0.043)。腿部伤口愈合障碍(11.1% 对 0%;p = 0.011)仅发生在 SV 组,而手臂伤口感染仅发生在 RA 组。74.8%的病例实现了完全随访。中位随访时间为 60.3 (39.6; 73.2) 个月。随访期间,严重不良心脑事件(19.0 vs. 22.7%; p = 0.675)和死亡率(14.5 vs. 6.7%; p = 0.167)在各组间无显著差异。心肌梗死(0 对 2.5%;p = 1.000)和中风(0 对 7.5%;p = 0.245)仅见于 RA 组。只有 RA 组患者需要经皮冠状动脉介入治疗(0 对 15.0%;P = 0.028)。两组患者均未再次接受冠状动脉旁路移植术(CABG)。SV 组患者的移植物血管造影合格,吻合口开放。RA 组有一名患者出现移植物失败,在这种情况下,移植物和原生冠状血管都被植入了支架。Kaplan-Meier分析显示,与RA组相比,SV组的存活率没有明显劣势:结论:在 LIMA 和一段 SV 之间进行复合 T 型移植物的 CABG 与在 LIMA 和 RA 之间进行复合 T 型移植物的搭桥手术效果相当。就中期观察期的发病率和死亡率而言,这可能是真实的。我们的研究结果提出了一个假设,即决定不进行主动脉旁路吻合术可能比选择移植材料更重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery-Comparison of the Great Saphenous Vein with the Radial Artery.

Background:  Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context.

Methods:  Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures.

Results:  A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac-cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan-Meier analysis revealed no significant survival disadvantage for SV group compared with RA group.

Conclusion:  CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.

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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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