Korean Circulation Journal

  • 제42권2호
  • /
  • Pages.107-112
  • /
  • 2012
  • /
  • 1738-5520(pISSN)
  • /
  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
권호 표지
DOI QR코드

DOI QR Code

Comparison of the Radial Artery and Saphenous Vein as Composite Grafts in Off-Pump Coronary Artery Bypass Grafting in Elderly Patients: A Randomized Controlled Trial

  • Song, Suk-Won (Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Sul, Soon-Young (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Hee-Jung (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Yoo, Kyung-Jong (Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine)
  • 발행 : 2012.02.29
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: Arterial grafts have a better long-term patency rate than saphenous vein (SV) when used in off-pump coronary artery bypass surgery (OPCAB). However, arterial grafts in elderly patients are often diseased. We sought to compare the early outcomes achieved by using the two different types of composite grafts. Subjects and Methods: We conducted a randomized trial to compare radial artery (RA) and SV composite grafts based on the in situ left internal mammary artery in 60 elderly (>70 years old) patients, who were scheduled to undergo OPCAB. Clinical outcomes and 1-year postoperative CT angiography results were compared. The quality of the conduit was evaluated by employing vascular ultrasonography, optical coherence tomography (OCT), and histologic examination. Results: No differences in immediate postoperative morbidity and mortality were observed between the two groups. Early postoperative CT angiography revealed a SV patency rate of 100%, which was not different from that of RA composite grafts (99.1%). CT angiography after a year showed an overall patency rate of 96.3%. The overall patency rate of the SV group at 1 year was 94.7%, which was similar to that of the RA group (97.4%). Also, there was no difference in overall survival rate between the two groups. Vascular ultrasonographic images showed strong correlations between OCT and histopathology. Conclusion: Our analysis of early outcomes revealed that the SV could be used as an alternative composite graft to the RA in elderly patients. Vascular ultrasonography is an accurate, real-time, and reproducible method for assessing the quality of the RA conduit.

키워드

참고문헌

  1. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary- artery graft on 10-year survival and other cardiac events. N Engl J Med 1986;314:1-6. https://doi.org/10.1056/NEJM198601023140101
  2. Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts: effects on survival over a 15-year period. N Engl J Med 1996;334:216-9. https://doi.org/10.1056/NEJM199601253340402
  3. Tagusari O, Kobayashi J, Bando K, et al. Total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system: clinical outcome and angiographic evaluation. Ann Thorac Surg 2004;78:1304-11. https://doi.org/10.1016/j.athoracsur.2004.03.094
  4. Fukui T, Takanashi S, Hosoda Y, Suehiro S. Total arterial myocardial revascularization using composite and sequential grafting with the offpump technique. Ann Thorac Surg 2005;80:579-85. https://doi.org/10.1016/j.athoracsur.2005.03.053
  5. Kim WS, Lee J, Lee YT, et al. Total arterial revascularization in triple-vessel disease with off-pump and aortic no-touch technique. Ann Thorac Surg 2008;86:1861-5. https://doi.org/10.1016/j.athoracsur.2008.06.025
  6. Glineur D, Hanet C, Poncelet A, et al. Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: a prospective randomized clinical, functional, and angiographic midterm evaluation. J Thorac Cardiovasc Surg 2008;136:482-8. https://doi.org/10.1016/j.jtcvs.2008.01.016
  7. Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Late results of conventional versus all-arterial revascularization based on internal thoracic and radial artery grafting. Ann Thorac Surg 2009; 87:19-26. e2. https://doi.org/10.1016/j.athoracsur.2008.09.050
  8. Tatoulis J, Buxton BF, Fuller JA, et al. Long-term patency of 1108 radial arterial-coronary angiograms over 10 years. Ann Thorac Surg 2009;88: 23-9. https://doi.org/10.1016/j.athoracsur.2009.03.086
  9. Halbersma WB, Arrigoni SC, Mecozzi G, et al. Four-year outcome of OPCAB no-touch with total arterial Y-graft: making the best treatment a daily practice. Ann Thorac Surg 2009;88:796-801. https://doi.org/10.1016/j.athoracsur.2009.04.104
  10. Osika W, Dangardt F, Gronros J, et al. Increasing peripheral artery intima thickness from childhood to seniority. Arterioscler Thromb Vasc Biol 2007;27:671-6. https://doi.org/10.1161/01.ATV.0000256468.95403.6f
  11. Ozkan S, Akay TH, Gultekin B, et al. Atherosclerosis of radial and internal thoracic arteries used in coronary bypass: atherosclerosis in arterial grafts. J Card Surg 2007;22:385-9. https://doi.org/10.1111/j.1540-8191.2007.00431.x
  12. Burris N, Schwartz K, Tang CM, et al. Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery. J Thorac Cardiovasc Surg 2007;133:419-27. https://doi.org/10.1016/j.jtcvs.2006.09.056
  13. Kobayashi H, Kitamura S, Kawachi K, Morita R, Konishi Y, Tsutsumi M. A pathological and biochemical study of arteriosclerosis in the internal thoracic artery, a vessel commonly used as a graft in coronary artery bypass surgery. Surg Today 1993;23:697-703. https://doi.org/10.1007/BF00311708
  14. Singh RA, Sosa JA, Green GE. Long-term fate of the internal mammary artery and saphenous vein graft. J Thorac Cardiovasc Surg 1983;86: 359-63.
  15. Sims FH. A comparison of coronary and internal mammary arteries and implications of the results in the etiology of arteriosclerosis. Am Heart J 1983;105:560-6. https://doi.org/10.1016/0002-8703(83)90478-7
  16. Sperti G, Manasse E, Kol A, et al. Comparison of response to serotonin of radial artery grafts and internal mammary grafts to native coronary arteries and the effect of diltiazem. Am J Cardiol 1999;83:592-6. https://doi.org/10.1016/S0002-9149(98)00920-5
  17. Segarra G, Medina P, Vila JM, et al. Contractile effects of arginine analogues on human internal thoracic and radial arteries. J Thorac Cardiovasc Surg 2000;120:729-36. https://doi.org/10.1067/mtc.2000.109537
  18. Van Son JA, Smedts F, Vincent JG, van Lier HJ, Kubat K. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 1990;99:703-7.
  19. Tatoulis J, Buxton BF, Fuller JA, Royse AG. Total arterial coronary revascularization: techniques and results in 3,220 patients. Ann Thorac Surg 1999;68:2093-9. https://doi.org/10.1016/S0003-4975(99)01150-9
  20. Souza DS, Johansson B, Bojo L, et al. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg 2006;132:373-8. https://doi.org/10.1016/j.jtcvs.2006.04.002

피인용 문헌

  1. Radial artery graft vs. saphenous vein graft for coronary artery bypass surgery : Which conduit offers better efficacy? vol.39, pp.4, 2012, https://doi.org/10.1007/s00059-013-3848-5
  2. Mid-Term Patency in Radial Artery and Saphenous Vein After Coronary Artery Bypass Grafting in Asymptomatic Patients Using 128-Slice CT Coronary Angiography vol.5, pp.1, 2012, https://doi.org/10.5812/aapm.23799
  3. Ten-year real-life effectiveness of coronary artery bypass using radial artery or great saphenous vein grafts in a single centre Chinese hospital vol.25, pp.4, 2012, https://doi.org/10.1093/icvts/ivx174
  4. Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery vol.378, pp.22, 2018, https://doi.org/10.1056/nejmoa1716026
  5. Radial Artery Versus Saphenous Vein Grafts in Coronary Artery Bypass Surgery: a Literature Review vol.21, pp.5, 2012, https://doi.org/10.1007/s11886-019-1112-1
  6. Radial artery versus saphenous vein as the second conduit for coronary artery bypass surgery: A meta-analysis vol.157, pp.5, 2012, https://doi.org/10.1016/j.jtcvs.2018.08.123
  7. Fruit salad vol.157, pp.5, 2012, https://doi.org/10.1016/j.jtcvs.2018.11.059
  8. Apples remain apples NO matter what vol.157, pp.5, 2012, https://doi.org/10.1016/j.jtcvs.2018.12.005
  9. Arterial Grafts for Coronary Bypass : A Critical Review After the Publication of ART and RADIAL vol.140, pp.15, 2012, https://doi.org/10.1161/circulationaha.119.041096
  10. The RADial artery International ALliance (RADIAL) extended follow-up study: rationale and study protocol vol.56, pp.6, 2019, https://doi.org/10.1093/ejcts/ezz247
  11. Angiographic Outcome of Coronary Artery Bypass Grafts: The Radial Artery Database International Alliance vol.109, pp.3, 2012, https://doi.org/10.1016/j.athoracsur.2019.07.010
  12. Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective vol.35, pp.5, 2020, https://doi.org/10.1111/jocs.14537
  13. Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting : A Systematic Review and Meta-analysis vol.324, pp.2, 2012, https://doi.org/10.1001/jama.2020.8228
  14. Direct angiography demonstrates equal 8-12 years patency rates of radial artery and saphenous vein grafts vol.54, pp.5, 2012, https://doi.org/10.1080/14017431.2020.1784454
  15. The Use of Radial Artery for CABG: An Update vol.2021, pp.None, 2012, https://doi.org/10.1155/2021/5528006
  16. Angiographic Patency of Coronary Artery Bypass Conduits: A Network Meta‐Analysis of Randomized Trials vol.10, pp.6, 2012, https://doi.org/10.1161/jaha.120.019206