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在加利福尼亚州进行多血管冠状动脉旁路手术的第二动脉对静脉导管

Andrew B Goldstone^1,2, Peter Chiu^1,2, Michael Baiocchi³

¹Department of Cardiothoracic Surgery (A.B.G., P.C., H.W., B.L., J.H.B., Y.J.W.).

|December 16, 2017

概括

在冠状动脉旁路移植中使用第二条动脉导管可显著降低死亡率和心血管事件. 射线动脉是右侧胸内动脉的首选第二通道,这增加了胸部伤口感染的风险.

科学领域:

心血管外科
血管移植
临床结果研究

背景情况:

在多血管冠状动脉绕道移植 (CABG) 中使用左侧内胸动脉以外的第二动脉管的好处尚未得到充分证实.
在美国,除左侧胸内动脉外的动脉管很少用于CABG手术.

研究的目的:

使用第二动脉管与静脉管的多血管CABG结果进行比较.
评估不同的第二动脉导管的安全性和有效性,特别是右侧的内胸动脉和半径动脉.

主要方法:

来自加利福尼亚州的全州临床注册 (2006-2011) 用于比较接受初级,分离多血管CABG的患者的结果.
根据34个手术前特征进行倾向性评分匹配,对接受第二条动脉管道 (n=5866) 或静脉管道 (n=53,566) 的队列进行了匹配,得到了5813组匹配.
分组分析对右内胸动脉 (n=1576) 和半径动脉 (n=4290) 移植患者的结果进行了比较.

主要成果:

在2006年至2011年期间,二次动脉导管使用率从10.7%下降到9.1%.
与静脉导管患者相比,接受第二次动脉导管患者的7年死亡率 (10. 6% vs 13. 1%) 和心肌梗塞和重复血管化率显著降低.
虽然右内胸动脉和半径动脉移植显示出相似的死亡率和心血管事件率,但右内胸动脉与胸部伤口感染的风险更高.

结论:

尽管使用率下降,但CABG中的第二动脉管与改善的存活率和减少的心血管事件有关.
与右侧内胸动脉相比,辐射动脉似乎是一个更好的第二导管,因为其效果相似,胸部伤口感染的风险较低.
这些发现支持考虑在CABG手术中使用动脉移植的门.

关键词:

冠状动脉绕道内胸动脉倾向性得分射线动脉

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