The Right Internal Thoracic Artery: The Forgotten Conduit-5,766 Patients and 991 Angiograms
The Right Internal Thoracic Artery: The Forgotten Conduit-5,766 Patients and 991 Angiograms
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DOI：
10.1016/j.athoracsur.2011.03.099
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发表时间：
2011-07-01
影响因子：
4.6
通讯作者：
Fuller, John A.
中科院分区：
文献类型：
--
作者：
Tatoulis, James;Buxton, Brian F.;Fuller, John A.
背景右胸廓内动脉（RITA）在生物学上与左ITA相同，但很少用于冠状动脉旁路移植术（CABG）。我们检查了RITA移植物的结果和长期通畅性。在1986年至2008年期间，991个连续的RITA移植物血管造影片的术后心脏症状进行了评价，由两个独立的观察员。如果移植物有大于80%的狭窄、弦状征或完全闭塞，则认为移植物不通畅。通过冠状动脉区域（无论是原位还是游离RITA）检查随时间推移的通畅性，并与其他管道进行比较。前瞻性收集临床结果，并通过国家死亡指数。共有5，766例患者接受了RITA移植物作为双侧ITA CABG手术的一部分。手术死亡率为1.1%;深部胸骨感染1.5%。在研究的7，780根冠状动脉导管中，检查了991根RITA导管;术后平均100 +/- 60个月（1 - 288个月）。总体10年RITA通畅率为90%。10年时RITA移植物对左前降支动脉（LAD; n = 149）的通畅率为95%，15年时为90%。回旋支边缘（Cx; n = 436）的10年RITA通畅率为91%，右冠状动脉（n = 199）为84%（p < 0.001），后降支（n = 207）为86%。LAD和Cx的十年RITA和LITA专利分别为95%和96%，以及91%和89%。原位RITA（n = 450）和游离RITA（n = 541）的10年通畅率相似（89% vs 91%; p = 0.44）。RITA的通畅率始终优于桡动脉（p < 0.01）和大隐静脉（p < 0.001）。在RITA血管造影中未观察到动脉粥样硬化变化。三支冠状动脉病变患者行RITA和LITA的10年生存率为89%。RITA的晚期通畅性非常好，与相同区域的LITA相当，始终优于桡动脉和隐静脉移植物，并且保持无粥样硬化。在三支冠状动脉病变患者中，除LITA外还使用RITA与良好的生存率相关。建议在CABG中更广泛地使用RITA。(Ann Thorac Surg 2011;92：9-17）（C）2011年，胸外科医师协会
Background. The right internal thoracic artery (RITA) is biologically identical to the left ITA, yet is rarely used in coronary artery bypass graft surgery (CABG). We examined the results and long-term patency of RITA grafts.Methods. Between 1986 and 2008, 991 consecutive RITA graft angiograms for postoperative cardiac symptoms were evaluated by two independent observers. Grafts were considered nonpatent if they had a greater than 80% stenosis, string sign, or total occlusion. Patency was examined over time by coronary territory, whether in situ or free RITA, and compared with other conduits. Clinical results were collected prospectively and by the National Death Index.Results. A total of 5,766 patients had a RITA graft as part of a bilateral ITA CABG procedure. Operative mortality was 1.1%; deep sternal infection 1.5%. Of 7,780 coronary conduits studied, 991 RITA conduits were examined; a mean of 100 +/- 60 months postoperatively (1 to 288 months). Overall ten-year RITA patency was 90%. The RITA graft patency to the left anterior descending artery (LAD; n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal (Cx; n = 436) was 91%, right coronary artery (n = 199) was 84% (p < 0.001), and posterior descending artery (n = 207) was 86%. Ten-year RITA and LITA patencies to the LAD were identical (95% vs 96%) and to the Cx (91% vs 89%), respectively. In situ RITA (n = 450) and free RITA (n = 541) had similar ten-year patencies (89% vs 91%; p = 0.44). The RITA patency was always better than the radial artery (p < 0.01) and saphenous vein grafts (p < 0.001). Atheromatous changes were not seen in the RITA angiograms. Ten-year survival of patients with RITA and LITA for triple-vessel coronary disease was 89%.Conclusions. Late patencies of RITA are excellent, equivalent to the LITA for identical territories, always better than radial arteries and saphenous vein grafts, and remain free of atheroma. Use of RITA in addition to LITA is associated with excellent survival in triple-vessel coronary disease. More extensive use of the RITA in CABG is recommended. (Ann Thorac Surg 2011;92:9-17) (C) 2011 by The Society of Thoracic Surgeons