不同冠状静脉动脉化旁路移植治疗弥漫性右冠状动脉侠窄病变

摘要

目的 探讨以大隐静脉和乳内动脉为旁路移植血管的冠状静脉动脉化旁路移植方案对弥漫性右冠状动脉狭窄病变患者生存率、心绞痛复发率和心脏功能的影响.方法 回顾性收集2011年1月至2017年6月64例弥漫性右冠状动脉狭窄病变行冠状静脉动脉化旁路移植术患者的临床资料.根据移植血管不同分为大隐静脉组(40例)和乳内动脉组(24例),比较两组随访生存率、旁路移植血管/心中静脉通畅率、心绞痛复发率、手术前后NYHA分级、左心室射血分数(LVEF)及左心室舒张末径(LVEDD)水平.结果 组内比较,两组术后1年的NYHA心功能分级、LVEF及LVEDD水平均显著优于术前,差异有统计学意义(P＜0.05).组间比较,乳内动脉组旁路移植血管/心中静脉通畅率和心绞痛复发率均显著优于大隐静脉组,差异有统计学意义(P＜0.05).术后1年,两组在NYHA心功能分级、LVEF、LVEDD水平和随访生存率方面差异均无统计学意义(P＞0.05).结论 大隐静脉和乳内动脉作为旁路移植血管行冠状静脉动脉化旁路移植术治疗弥漫性右冠状动脉狭窄病变,两者随访生存率和远期心功能改善效果相似.选用乳内动脉更有助于提高旁路移植血管/心中静脉通畅率,避免心绞痛复发.%Objective To investigate the effects of coronary artery bypass grafting in different bypass grafts on survival rate,angina recurrence rate and cardiac function in patients with diffuse right coronary artery disease.Methods Sixty-four patients with diffuse right coronary artery stenosis admitted to the hospital were enrolled.All patients underwent coronary artery bypass grafting and were divided into large saphenous vein group(40 cases) and internal mammary artery group(24 cases) according to the difference of graft vessels.The follow-up survival rate,bypass graft vascular/cardiac venous patency rate,angina recurrence rate,NYHA classification before and after surgery,left ventricular ejection fraction(LVEF),and left ventricular diastolic end diameter(LVEDD) level of both groups were compared.Results Comparison in the same group,NYHA cardiac function grading,LVEF and LVEDD levels were better than those before surgery(P ＜ 0.05).Compared with the great saphenous vein group,the difference of the venous patency/intracardiac venous patency rate and angina pectoris was better in the internal mammary artery group (P ＜ 0.05).At 1 year after operation,there was no significant difference in NYHA cardiac function grading,LVEF,LVEDD level and follow-up survival rate(P ＞0.05).Conclusion There is no significant difference in follow-up survival rate and long-term improvement of cardiac function between patients with diffuse right coronary artery stenosis undergoing coronary venous artery bypass grafting with saphenous vein and internal mammary artery bypass graft.However,the internal mammary artery is more helpful to improve the patency of the bypass graft vessel/cardiac vein and avoid the recurrence of angina pectoris.