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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (9): 84-91.doi: 10.6040/j.issn.1671-7554.0.2024.1063

• 临床医学 • 上一篇    

游离右内乳动脉与桡动脉构建Y桥在全动脉冠脉旁路移植术多中心应用效果

国科1,陈绪军2,施超3,罗俊辉4,杨岷5,王晓武6,王振东7,李有金8,孟春营9,陈文生10   

  1. 1.遵义医科大学附属医院心脏大血管外科, 贵州 遵义 563003;2.华中科技大学同济医学院, 武汉市第一医院心外科, 湖北 武汉 430022;3.蚌埠医科大学附属第一医院心外科, 安徽 蚌埠 233004;4.中国人民解放军联勤部队989医院心胸外科, 河南 洛阳 471031;5.江南大学附属医院心脏大血管外科, 江苏 无锡 214122;6.南方医科大学珠江医院心外科, 广东 广州 510282;7.临汾市人民医院心外科, 山西 临汾 041000;8.宁夏自治区人民医院心外科, 宁夏 银川 750002;9.深圳市人民医院心外科, 广东 深圳 518020;10.西安高新医院心外科, 陕西 西安 710075
  • 发布日期:2025-09-08
  • 通讯作者: 陈绪军. E-mail:chenstan@163.com

Outcomes of a Y-composite arterial graft using free right internal mammary artery and radial artery for patients undergoing total arterialization myocardial revascularization in multi-center in China

GUO Ke1, CHEN Xujun2, SHI Chao3, LUO Junhui4, YANG Min5, WANG Xiaowu6, WANG Zhendong7, LI Youjin8, MENG Chunying9, CHEN Wensheng10   

  1. 1. Department of Cardiovascular Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou, China;
    2. Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China;
    3. Department of Cardiac Surgery, the First Affiliated Hospital of Bengbu Medical University, Bengbu 230004, Anhui, China;
    4. Department of Cardiothoracic Surgery, the 989th Hospital of PLA Joint Logistics, Luoyang 471031, Henan, China;
    5. Department of Cardiac Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214122, Jiangsu, China;
    6. Department of Cardiac Surgery, Zhujiang Hospital of Nanfang University, Guangzhou 510282, Guangdong, China;
    7. Department of Cardiac Surgery, Linfen Peoples Hospital, Linfen 041000, Shanxi, China;
    8. Department of Cardiac Surgery, Peoples Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia, China;
    9. Department of Cardiac Surgery, Shenzhen Peoples Hospital, Shenzhen 518020, Guangdong, China;
    10. Department of Cardiothoracic Surgery, Xian Gaoxin Hospital, Xian 710075, Shaanxi, China
  • Published:2025-09-08

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摘要： 目的 评价在全动脉冠状动脉旁路移植术(total arterialization myocardial revascularization, TAR)中运用游离带蒂右内乳(free right internal mammary artery, fRIMA)与桡动脉(radial artery, RA)构建复合Y动脉桥(fRIMA-RA-Y 桥)的安全性与效果。 方法 纳入2020年1月至2024年5月在10家医院接受TAR手术中运用fRIMA与RA构建fRIMA-RA-Y 桥患者112例,其中,男91例、女21例,30~70(55.5±11.7)岁。对围手术期资料及术后随访数据包括生存、心脏超声、CT血管造影(CT angiography, CTA)进行分析。 结果 所纳入病例均为多支病变,其中重度左主干病变40例;合并糖尿病72例。TAR均为体外循环下手术。升主动脉阻断时间为61~100(57.5±11.4)min,体外循环时间为79~127(113.4±19.2)min。在112例TAR患者中,共取带蒂左内乳动脉112支、左RA 112支、右RA 100支、fRIMA 112支;共构建fRIMA-RA-Y 桥112支。远端吻合口3~5(4.2±0.7)个。气管插管时间与平均ICU停留时间分别为1~18(10.5±7.7)h与12~117(23.5±12.9)h。手术死亡1例。7例(7.69%)患者术中安装主动脉内球囊反搏。术后心房颤动22例,前臂血肿7例,术后左胸腔出血5例,急性肾功能不全5例,均治愈出院。未发生胸骨感染并发症。随访2~49(34.3±5.5)个月,随访率75.89%,术后平均左室射血分数较术前有显著性改善［(53.3±5.3)% vs.(62.0±4.5)%,t=17.16,P<0.001］。随访患者全部存活,无主要心脑血管事件发生。随访CTA提示fRIMA-RA-Y桥通畅率为94.12%。 结论 在TAR患者中利用fRIMA与RA在左冠系统构建fRIMA-RA-Y复合动脉桥可能是安全有效的。

关键词: 冠状动脉旁路移植术, 全动脉化, 游离右内乳动脉, 桡动脉, 复合动脉Y桥, 多中心

Abstract: Objective To evaluate the safety and efficacy of a composite Y arterial graft(fRIMA-RA-Y graft)using free right internal mammary artery(fRIMA)and radial artery(RA)for patients undergoing total arterial myocardial revascularization(TAR). Methods From January 2020 to May 2024, 112 patients who underwent TAR in 10 hospitals in China and used fRIMA and RA to construct fRIMA-RA-Y bridges were included, including 91 males and 21 females, aged 55.5±11.7 years. Perioperative data and follow-up data after surgery, including survival, echocardiography, and CT angiography(CTA), were collected and analyzed. Results Coronary lesions in all patients were multiple-vessel disease, with 40 cases of severe left main disease. There were 72 patients with diabetes mellitus. All patient underwent TAR by on pump technique. The duration of aorta cross-clamping was 61-100(57.5±11.4)mins and cardiopulmonary bypass time was 79-127(113.4±19.2)mins. Among 112 TAR patients, 112 pedicled LIMA, 112 left RA, 100 right RA and 112 fRIMA conduits were harvested. A total of 112 fRIMA-RA-Y grafts were constructed in in left coronary territory. The number of distal anastomoses was 3-5(4.2±0.7). The duration of mechanical ventilation and ICU stay was 1-18(10.5±7.7)hours and 12-117(23.5±12.9)hours respectively. There was one surgical death. A percent of 7.69%(7/112)of patients were implanted with intraoperative aortic balloon bump. There were 22 patients of new set postoperative atrial fibrillation, 7 of forearm hematoma, 5 of postoperative left chest hemorrhage and 5 of acute renal insufficiency. No chest bone infection occurred. The follow-up duration was 2-49(34.3±5.5)months, with a follow-up rate of 75.89%. There was a significant improvement in left ventricular ejection fraction compared to that of before surgery ［(53.3±5.3)% vs.(62.0±4.5)%, t=17.16, P<0.001］). All patients survived without major adverse cardiovascular or cerebrovascular events during follow-up. It was showed in CTA examination that graft patency of fRIMA-RA-Y graft was 94.12%. Conclusion This multi-center study indicates that fRIMA-RA-Y composite arterial grafts in left coronary territory appears to be safe and effective in TAR patients.

Key words: Coronary artery bypass grafting, Total arterial myocardial Revascularization, Free right internal mammary artery, Radial artery, composite arterial Y grafts, Multi-center

中图分类号: 

  • R654
[1] Schwann TA, Habib RH, Wallace A, et al. Operative outcomes of multiple-arterial versus single-arterial coronary bypass grafting[J]. Ann Thorac Surg, 2018, 105(4): 1109-1119.
[2] Gaudino M, Benedetto U, Fremes S, et al. Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery[J]. N Engl J Med, 2018, 378(22): 2069-2077.
[3] Rocha RV, Tam DY, Karkhanis R, et al. Long-term outcomes associated with total arterial revascularization vs non-total arterial revascularization[J]. JAMA Cardiol, 2020, 5(5): 507-514.
[4] Ren J, Tian DH, Gaudino M, et al. Survival benefit of multiple arterial revascularization with and without supplementary saphenous vein graft[J]. J Am Heart Assoc, 2023, 12(22): e031986. doi: 10.1161/JAHA.123.031986
[5] Shapira OM. Radial artery as the preferred second conduit for coronary bypass[J]. N Engl J Med, 2018, 378(22): 2134-2135.
[6] Sabik JF, Mehaffey JH, Badhwar V, et al. Multiarterial vs single-arterial coronary surgery: 10-year follow-up of 1 million patients[J]. Ann Thorac Surg, 2024, 117(4): 780-788.
[7] Shapira OM, Idais I, Aviel G. The best conduits, by the best surgeons, for the best outcomes[J]. J Am Coll Cardiol, 2019, 74(10): 1286-1289.
[8] Taggart DP, Benedetto U, Gerry S, et al. Bilateral versus single internal-thoracic-artery grafts at 10 years[J]. N Engl J Med, 2019, 380(5): 437-446.
[9] Buxton BF, Hayward PA, Raman J, et al. Long-term results of the RAPCO trials[J]. Circulation, 2020, 142(14): 1330-1338.
[10] Gaudino M, Bakaeen FG, Sandner S, et al. Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery(EACTS)and The Society of Thoracic Surgeons(STS)[J]. Eur J Cardiothorac Surg, 2023, 166(4): 1099-1114.
[11] 陈绪军, 郑宝石, 张永, 等. 冠状动脉旁路移植术双桡动脉桥多中心应用的中期结果[J]. 中华医学杂志, 2019, 99(14): 1069-1074. CHEN Xujun, ZHENG Baoshi, ZHANG Yong, et al. Mid-term multi-center outcomes of bilateral radial artery as conduits in coronary artery bypass grafting[J]. National Medical Journal of China, 2019, 99(14): 1069-1074.
[12] 刘达兴, 陈绪军, 郑宝石, 等. 体外循环下全动脉冠状动脉旁路移植治疗左室功能低下冠心病多中心临床观察[J]. 中华医学杂志, 2020, 100(18): 1390-1395. LIU Daxing, CHEN Xujun, ZHENG Baoshi, et al. On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: a multi-center retrospective study[J]. National Medical Journal of China, 2020, 100(18): 1390-1395.
[13] 刘达兴, 陈绪军, 张建, 等. 左桡动脉桥冠状动脉旁路移植术治疗右主干重度狭窄的中期结果[J]. 中华医学杂志, 2019, 99(42): 3313-3317. LIU Daxing, CHEN Xujun, ZHANG Jian, et al. Mid-term outcomes of coronary artery bypass surgery with left radial artery bypassed to right main coronary artery of severe stenosis[J]. National Medical Journal of China, 2019, 99(42): 3313-3317.
[14] Ashwat E, Brown JA, Yousef S, et al. Radial artery vs right internal mammary artery as a second conduit during coronary artery bypass grafting[J]. Am Heart J, 2024, 270: 44-54. doi: 10.1016/j.ahj.2024.01.006
[15] Tatoulis J, Buxton BF, Fuller JA. Results of 1, 454 free right internal thoracic artery-to-coronary artery grafts[J]. Ann Thorac Surg, 1997, 64(5): 1263-1268.
[16] Tatoulis J, Buxton BF, Fuller JA. The right internal thoracic artery: the forgotten conduit: 5, 766 patients and 991 angiograms[J]. Ann Thorac Surg, 2011, 92(1): 9-15.
[17] 陈绪军, 张建, 李伟栋, 等. 2023年欧洲心胸外科协会和美国胸外科医师协会《冠状动脉旁路移植术旁路血管选择专家共识》解读[J]. 中华外科杂志, 2024, 62(1): 44-48. CHEN Xujun, ZHANG Jiang, LI Weidong, et al. Interpretation on Expert systematic review on the choice of conduits for coronary artery bypass grafting endorsed by the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons in 2023[J]. Chinese Journal of Surgery, 2024, 62(1):45-49.
[18] Lamy A, Browne A, Sheth T, et al. Skeletonized vs pedicled internal mammary artery graft harvesting in coronary artery bypass surgery: a post hoc analysis from the COMPASS trial[J]. JAMA Cardiol, 2021, 6(9): 1042-1049.
[19] Gaudino M, Audisio K, Rahouma M, et al. Comparison of long-term clinical outcomes of skeletonized vs pedicled internal thoracic artery harvesting techniques in the arterial revascularization trial[J]. JAMA Cardiol, 2021, 6(12): 1380-1386.
[20] Ratnaraj V, Tripathy AK, Ivanov A, et al. Baby Y anastomosis, the journey towards total arterial complete myocardial revascularization[J]. JTCVS Tech, 2023, 19: 52-57. doi: 10.1016/j.xjtc.2023.03.014
[21] Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J, 2019, 40(2): 87-165.
[22] Mavromatis K, Jones PG, Ali ZA, et al. Complete revascularization and angina-related health status in the ISCHEMIA trial[J]. J Am Coll Cardiol, 2023, 82(4): 295-313.
[23] Stone GW, Ali ZA, OBrien SM, et al. Impact of complete revascularization in the ISCHEMIA trial[J]. J Am Coll Cardiol, 2023, 82(12): 1175-1188.
[24] Buxton BF, Ruengsakulrach P, Fuller J, et al. The right internal thoracic artery graft: benefits of grafting the left coronary system and native vessels with a high grade stenosis[J]. Eur J Cardiothorac Surg, 2000, 18(3): 255-261.
[25] Royse AG, Bellomo R, Royse CF, et al. Radial artery vs bilateral mammary composite Y coronary artery gra-fting: 15-year outcomes[J]. Ann Thorac Surg, 2021, 111(6): 1945-1953.
[26] Singh B, Singh G, Tripathy A, et al. Comparing the patency of the left internal mammary in single, sequential, and Y grafts[J]. J Thorac Cardiovasc Surg, 2024, 167(1): 176-182.
[27] Misra S, Srinivasan A, Jena SS, et al. Myocardial protection in adult cardiac surgery with del nido versus blood cardioplegia: a systematic review and meta-analysis[J]. Heart Lung Circ, 2021, 30(5): 642-655.
[28] 国科, 陈绪军, 郑宝石, 等. 解剖完全再血管化全动脉冠脉旁路移植术多中心应用中期结果[J]. 山东大学学报(医学版), 2025, 63(5): 18-25. GUO Ke, CHEN Xujun, ZHENG Baoshi, et al. Multi-center mid-term clinical outcomes in coronary patients undergoing total arterial bypass surgery with anatomic complete revascularization in China[J]. Journal of Shandong University(Health Sciences), 2025, 63(5): 18-25.
[29] 国科, 陈绪军, 郑宝石, 等. 快通道拔管在全动脉冠脉旁路移植术的多中心临床效果[J]. 山东大学学报(医学版), 2025, 63(5): 26-32. GUO Ke, CHEN Xujun, ZHENG Baoshi, et al. Multi-center clinical outcomes of fast-track extubation in total arterial coronary bypass grafting in China[J]. Journal of Shandong University(Health Sciences), 2025, 63(5): 26-32.
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