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著者: Paul Achouh, Redha Boutekadjirt, Daniel Toledano, Nadjib Hammoudi, Jean-Yves Pagny, Pascal Goube, Khaled Ould Isselmou, Bernard Lancelin, Régis Fouquet, Christophe Acar
雑誌名: J Thorac Cardiovasc Surg. 2010 Jul;140(1):73-9, 79.e1-2. doi: 10.1016/j.jtcvs.2009.09.032. Epub 2009 Nov 26.
Abstract/Text
OBJECTIVE: The aim of this study was to assess the angiographic results of the radial artery as a coronary bypass conduit at long term (>5 years).
METHODS: Radial artery grafts were controlled in 202 patients at 10.1 years by conventional angiography (n = 79) and computed tomography (n = 123). Clinical or paraclinical evidence of ischemia was noted in 81 patients, whereas 121 patients were asymptomatic. Some 520 conduits were controlled: radial artery (n = 230), left internal thoracic artery (n = 190), right internal thoracic artery (n = 30), and veins (n = 70). Radial arteries were anastomosed to the right coronary (24%), marginal (58%), diagonal (16%), and left anterior descending (<1%) arteries, whereas left internal thoracic arteries were primarily anastomosed to the left anterior descending artery (95%). The mean number of antithrombotic and anti-anginal medications was 1.2 and 1.9 per patient, respectively.
RESULTS: The ejection fraction was slightly decreased compared with its preoperative value (54% +/- 11% vs 57% +/- 9%; P = .009). Nine reoperations were required at 10.5 years for valve replacement (n = 8) and isolated bypass (n = 1). Percutaneous intervention was performed in 48 patients (24%) at 7.6 years on a graft (28%) or a native coronary artery (72%). The 10-year patency of radial artery grafts was 83%, which was lower than the patency of left internal thoracic arteries (95%, P < .001) and similar to the patency of right internal thoracic arteries (87%, P = .66) and veins (81%, P = .50). No medication seemed to influence radial artery graft patency (aspirin: P = .26; calcium blockers: P = .36). All graft patency was lower when clinical or paraclinical evidence of ischemia was present than in asymptomatic cases (83% vs 90% P = .02). The patency of left anterior descending grafts was higher than that of non-left anterior descending grafts (96% vs 82% P < .001).
CONCLUSION: The radial artery-to-coronary bypass conduit provided a low coronary reoperation rate with an excellent patency (83%) up to 20 years postoperatively.
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
PMID 19944433 J Thorac Cardiovasc Surg. 2010 Jul;140(1):73-9, 79.e1-2. doi: 10.1016/j.jtcvs.2009.09.032. Epub 2009 Nov 26.
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