Early angiographic evaluation after off-pump coronary artery bypass grafting
Early angiographic evaluation after off-pump coronary artery bypass grafting
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DOI：
10.1016/j.jtcvs.2012.08.057
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发表时间：
2013-11-01
影响因子：
6
通讯作者：
Sakata, Ryuzo
中科院分区：
文献类型：
--
作者：
Nakano, Jota;Okabayashi, Hitoshi;Sakata, Ryuzo
目的：非体外循环冠状动脉旁路移植术的潜在缺点之一是与常规冠状动脉旁路移植术相比，其通畅程度降低。本研究探讨了非体外循环冠状动脉搭桥术后的系统血管造影评价。方法：对1604例连续6年行非体外循环冠状动脉搭桥术的患者进行分析，其中1422例（89%）进行了术后血管造影。使用广义估计方程逻辑分析来研究移植物衰竭的潜在预测因素（FitzGibbon B或O）。结果：78%的患者使用双侧胸内动脉。远端吻合器平均数目为3.7±1.2。住院死亡率为0.4%。受体冠状动脉直径小于1.5 mm（优势比[OR]， 1.62； 95%可信区间[CI]， 1.24-2.11）是移植物失败的独立预测因素，而狭窄直径大于75%的百分比（OR, 0.71; 95% CI, 0.53-0.93）、顺序移植物（OR, 0.69; 95% CI, 0.51-0.94）和左主干疾病（OR, 0.72; 95% CI, 0.53-0.96）是保护因素。在每个导管的亚分析中，狭窄直径百分比对左胸内动脉衰竭具有保护作用（OR, 0.61），而较小的受体冠状动脉直径与右胃网膜动脉和隐静脉移植失败相关（OR，分别为2.37和2.36）。左旋动脉与胃网膜动脉移植失败相关，而序贯移植再次对胃网膜动脉具有保护作用（OR分别为4.39和0.33）。结论：较小的冠状动脉直径可能是移植物失败的一个预测因素，而狭窄直径大于75%的百分比、序贯移植物和左主干疾病可能是非体外循环旁路移植的保护因素。
Objectives: One of the potential drawbacks of off-pump coronary artery bypass is reduced patency compared with conventional coronary artery bypass. This study examined the systematic angiographic evaluation after off-pump coronary artery bypass.Methods: Of the 1604 consecutive patients who underwent off-pump coronary artery bypass over 6 years, 1422 (89%) who underwent postoperative angiography were analyzed. Generalized estimating equations logistic analyses were used to investigate potential predictors of graft failure (FitzGibbon B or O).Results: Bilateral internal thoracic arteries were used in 78% of the patients. The mean number of distal anastomoses was 3.7 +/- 1.2. The in-hospital mortality rate was 0.4%. Recipient coronary diameter less than 1.5 mm (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.24-2.11) was an independent predictor of graft failure, whereas percent stenosis diameter greater than 75% (OR, 0.71; 95% CI, 0.53-0.93), sequential graft (OR, 0.69; 95% CI, 0.51-0.94), and left main disease (OR, 0.72; 95% CI, 0.53-0.96) were protective factors. In the sub-analyses for each conduit, percent stenosis diameter was protective against left internal thoracic artery failure (OR, 0.61), whereas smaller recipient coronary diameter was associated with right gastroepiploic artery and saphenous vein graft failure (OR, 2.37 and 2.36, respectively). Left circumflex artery was associated with gastroepiploic artery graft failure, whereas sequential graft was again protective for the gastroepiploic artery (OR, 4.39 and 0.33, respectively).Conclusions: Smaller coronary diameter would be a predictor of graft failure, whereas percent stenosis diameter greater than 75%, sequential graft, and left main disease would be protective factors for off-pump bypass grafts.