序贯桥终末端与细小靶冠状动脉侧侧和端侧吻合的疗效对比

目的:评估不停跳冠状动脉旁路移植术中,分别采用侧侧吻合与端侧吻合方式缝合大隐静脉序贯桥终末端与细小靶冠状动脉的疗效。方法:回顾性分析2012年10月至2013年4月,行不停跳冠状动脉旁路移植术且终末靶冠状动脉细小的患者共89例。其中37例患者使用侧侧吻合术,即采用侧侧吻合方法缝合大隐静脉序贯桥终末端与靶冠状动脉;52例患者使用端侧吻合术,即将大隐静脉序贯桥终末端与靶冠状动脉进行端侧吻合。术中监测桥血管流量及搏动指数,术后6个月复查超声心动图、心电图等指标,以评估手术疗效。术后1年行双源CT冠状动脉造影检查,观察终末桥血管的通畅情况。结果:两组术中终末桥血管流量分别为(17.32±6.18)vs.(14.15±5.09)mL/min,P0.05],搏动指数分别为(2.50±1.08)vs.(3.47±0.74),P0.05]。两组患者在围术期内均无低心排出量综合征(低心排)、恶性心律失常及心肌梗死等不良事件发生。术后6个月复查超声心动图,提示两组患者心功能均较术前改善,但两组之间差异无统计学意义(P0.05)。术后随访1年时侧侧吻合组患者均无心绞痛发作,端侧吻合组有9例患者再发心绞痛。双源CT冠状动脉造影提示:侧侧吻合组中终末桥血管均保持通畅,而端侧吻合组中8例患者的终末桥血管再狭窄(P0.05)。随访截至2014年1月底,平均随访时间为(10.7±2.5)个月,患者随访率为100%,存活率为100%。结论:采用侧侧吻合术缝合大隐静脉序贯桥终末端与细小靶冠状动脉,可改善终末桥血管的通畅性。

Comparative study of the effect of sequential grafts distal end to small coronary artery with side-to-side and end-to-side anastomosis

Objective：To evaluate the efficacy of side-to-side and end-to-side anastomosis in sequential coronary artery bypass grafting of great saphenous veins to small coronary arteries.Methods：89 patients with small coronary vessels underwent off-pump coronary artery bypass grafting from October 2012 to April 2013.Side-to-side anastomosis of the distal end of vein graft to small target coronary artery performed in 37 cases （group 1） and end end-to-side anastomosis of the distal end of vein graft to small target coronary artery in 52cases （group 2）.The blood flow rate and pulsatility index of the grafts were monitored intra-operatively and the echocardiography and electrocardiography were performed six months after the surgery.Dual source CT coronary angiography was performed to evaluate the graft 1 year after surgery.Results：There was significant difference in intraoperative mean graft flow rate and pulsatility indexes of the graft between two groups （17.32 ± 6.18） mL/minvs.（14.15 ±5.09）mL/min and （2.50±1.08） vs.（3.47 ±0.74）,respectively （P＜0.05）.Nodeath,low cardiac output syndrome,malignant arrhythmias and perioperative myocardial infarction in each group.Echocardiography examined in 6 months after the surgery showed cardiac function improved with no statistical difference in both group.No recurrent angina was complained in the group 1 while 9 cases in the group 2.Dual source CT coronary angiography 1 year after surgery showed that all distal ends of grafts were patent in the group 1 and but restenosis of the distal end of graft in 8 cases in the group 2 （P ＜ 0.05）.All the patients were followed up until January 2014,mean follow-up time was （10.7 ± 2.5） months with 100％ of rate of follow-up and survival.Conclusion：Higher patency could be achieved in the distal end of sequential vein grafts to small target coronary artery by means of side-to-side anastomosis.It may be a promisingly novel revascularization technique for small coronary artery.