Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting
Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting
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DOI：
10.1111/jocs.15853
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发表时间：
2021-07-26
影响因子：
1.6
通讯作者：
Samano, Ninos
中科院分区：
文献类型：
--
作者：
Arbeus, Mikael;Souza, Domingos;Samano, Ninos
随机试验显示冠状动脉旁路移植术中无接触隐静脉移植物的长期通畅率较高。这些移植物在非体外循环冠状动脉搭桥手术中的通畅率尚未研究。我中心参与了冠状动脉随机试验NCT 00463294。这是一项旨在评估5年随访时非接触隐静脉在体外循环与非体外循环冠状动脉搭桥手术中的通畅性的研究。方法五十六例患者。49例患者中有40例在5年时存活，参加了此次随访。体外循环组21例，非体外循环组19例。无接触隐静脉用于旁路所有目标，在某些情况下，左前降支动脉。根据远端吻合，采用计算机断层扫描血管造影评价移植物通畅性。结果5年通畅率为123/139（88.5%）。非接触静脉移植物的通畅率在体外循环组为57/64（89.1%），在非体外循环组为37/45（82.2%）。除29/30（96.6%）例左胸廓内动脉外，其余均通畅。所有用于旁路左前降支和对角动脉的静脉移植物均通畅32/32。隐静脉的通畅率最低的是右冠状动脉区域，特别是在非体外循环手术中（80.0% vs. 62.5%，分别为非体外循环组）。结论非体外循环和非体外循环冠状动脉旁路移植术中，无接触隐静脉和左胸廓内动脉至左前降支区域的5年通畅率相当。非体外循环冠状动脉旁路移植术的移植物通畅率低于右冠状动脉。
Background Randomized trials show high long-term patency for no-touch saphenous vein grafts in coronary artery bypass grafting. The patency rate in off-pump coronary bypass surgery for these grafts has not been investigated. Our center participated in the CORONARY randomized trial, NCT00463294. This is a study aimed to assess the patency of no-touch saphenous veins in on- versus off-pump coronary bypass surgery at five-year follow-up. Methods Fifty-six patients were included. Forty of 49 patients, alive at 5 years, participated in this follow-up. There were 21 and 19 patients in the on- and off-pump groups respectively. No-touch saphenous veins were used to bypass all targets and in some cases the left anterior descending artery. Graft patency according to distal anastomosis was evaluated with computed tomography angiography. Results The five-year patency rate was 123/139 (88.5%). The patency for the no-touch vein grafts was 57/64 (89.1%) in the on-pump versus 37/45 (82.2%) in the off-pump group. All left internal thoracic arteries except for one, 29/30 (96.6%), were patent. All vein grafts used to bypass the left anterior descending and the diagonal arteries were patent 32/32. The lowest patency rate for the saphenous veins was to the right coronary territory, particularly in off-pump surgery (80.0% vs. 62.5% for the on- respective off-pump groups). Conclusions Comparable 5-year patency for the no-touch saphenous veins and the left internal thoracic arteries to the left anterior descending territory in both on- and off-pump coronary artery bypass grafting. Graft patency in off-pump CABG is lower to the right coronary artery.