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多重動脈移植は冠動脈バイパス移植患者のより良い結果と関連している
Rodolfo V Rocha1, Derrick Y Tam1,2, Reena Karkhanis1,2
1Division of Cardiac Surgery (R.V.R., D.Y.T., R.K., R.N., S.E.F.), University of Toronto, Ontario, Canada.
Circulation
|November 27, 2018
まとめ
3 つの動脈移植を用いた冠動脈バイパス移植 (CABG) は,2 つの動脈移植と比較して改善された結果を示さなかった. しかし,多重動脈移植 (MAG) は,患者の長期生存率と心疾患の発生率において,単一動脈移植 (SAG) を大幅に上回った.
科学分野:
- 心血管外科
- 胸部 外科
- 心臓手術 の 結果
背景:
- 冠動脈バイパス移植 (CABG) は冠動脈疾患の一般的な手術である.
- 過去の研究では 血管移植を2回行うと 患者の生存率が上昇すると示唆されています
- 3つの動脈移植の利点は不明である.
研究 の 目的:
- 3つの動脈移植と2つの動脈移植を用いたCABGの臨床結果を比較する.
- 多重動脈移植 (MAG) と単一動脈移植 (SAG) の長期的な有効性を評価する.
主な方法:
- カナダのオンタリオ州 (2008年−2016年) の孤立したCABG患者の遡及コホート分析.
- 3対2の動脈移植,およびMAG対2の動脈移植を比較するために,傾向スコアマッチングを使用した. SAG) となっている.
- 主要アウトカム:死亡,心筋梗塞,脳卒中,再循環 (主要心血管不良事件) の複合
主要な成果:
- 3対2の動脈移植の8年後の結果において,重大な心動脈および脳血管疾患または死亡率の有意な差は認められませんでした.
- 多重動脈移植 (MAG) は,単一の動脈移植 (SAG) に比べて,8年後の結果が有意に改善され,主要心血管不良が減少し,生存率が向上し,再発性再血管化は少なかった.
- 放射性動脈移植は3つの動脈移植群でより頻繁でした.
結論:
- CABGで3つの動脈移植を使用すると,8年間の追跡で2つの動脈移植よりも追加の臨床上の利点はありません.
- 多重動脈移植 (MAG) は,CABG患者における単一動脈移植 (SAG) よりも優れた長期的なアウトカムを示しています.
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