Sequential In Situ Left Internal Thoracic Artery Grafting to the Circumflex and Right Coronary Artery Areas
Sequential In Situ Left Internal Thoracic Artery Grafting to the Circumflex and Right Coronary Artery Areas
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DOI：
10.1016/j.athoracsur.2012.08.053
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发表时间：
2013-01-01
影响因子：
4.6
通讯作者：
Ozkara, Ahmet
中科院分区：
文献类型：
--
作者：
Bakay, Cihat;Onan, Burak;Ozkara, Ahmet
背景资料。已经提出了几种双侧胸内动脉(ITA)移植模式来加强三支冠状动脉的血运重建。我们报告了左ITA在旋支和右冠状动脉(RCA)区域的序贯原位移植的结果。2001年1月至2007年9月，102例3支冠状动脉病变患者接受了双侧原位ITA血管重建术。旋支和远端RCA分支与左侧ITA顺序吻合。在左前降支区域移植右ITA。对99例(97.0%)患者进行了37.2+/-2.9个月的监测，77例(75.4%)在27.8+/-5.8个月后进行了冠状动脉显像。双侧ITA桥通畅率为97.1%(Fitzgibbon A+B级)。左ITA与旋支和右冠状动脉的吻合通畅率为96.7%，其中3例为Fitzgibbon B级。旋支和RCA连续吻合通畅率分别为98.0%和95.0%。右后外侧动脉吻合通畅率为91.8%，右降后动脉吻合通畅率为100%。右冠状动脉左前降支原位移植物通畅率为98.0%(Fitzgibbon A+B级)。术后6个月心绞痛复发1例(0.9%)。经皮冠状动脉介入治疗3例(3.8%)。随访期内无心脏死亡。在有3支血管病变的患者中，连续的左ITA原位移植到旋转区和RCA区产生了可接受的中期结果。(Ann Thorac Surg 2013；95：63-70)(C)2013年，胸外科学会
Background. Several bilateral internal thoracic artery (ITA) grafting patterns have been proposed to enhance 3-vessel coronary artery revascularization. We present the outcomes of sequential in situ left ITA grafting to the circumflex and right coronary artery (RCA) areas.Methods. Between January 2001 and September 2007, 102 patients with 3-vessel coronary artery disease underwent arterial myocardial revascularization with bilateral in situ ITA grafts. The circumflex and distal RCA branches were revascularized sequentially with the left ITA. The left anterior descending artery area was grafted with the right ITA.Results. Ninety-nine patients (97.0%) were monitored for 37.2 +/- 2.9 months, and 77 (75.4%) underwent postoperative coronary imaging after 27.8 +/- 5.8 months. The bilateral ITA grafts were 97.1% patent (FitzGibbon grade A+B) overall. The sequential anastomoses of the left ITA to the circumflex and RCA territories were 96.7% patent overall, with competitive flow (FitzGibbon grade B) in 3 patients. The patency rates of sequential anastomoses to the circumflex and RCA branches were 98.0% and 95.0%, respectively. The right posterolateral and right descending posterior artery anastomoses were 91.8% and 100% patent, respectively. The in situ right ITA grafts to the left anterior descending artery area were 98.0% (FitzGibbon grade A+B) patent overall. Angina recurred in 1 patient (0.9%) 6 months after the operation. Percutaneous coronary interventions were performed in 3 patients (3.8%). No cardiac deaths occurred during the follow-up period.Conclusions. Sequential in situ left ITA grafting to the circumflex and RCA areas yields acceptable midterm results in selected patients with 3-vessel disease. (Ann Thorac Surg 2013;95:63-70) (C) 2013 by The Society of Thoracic Surgeons