冠状动脉桥血管远端支撑装置在右冠状动脉严重病变患者的应用  

Distal anastomosis support for patients with right coronary artery severe lesion

作　　者：李波[1] 王粮山 顾承雄[1] 李海涛[1] 杨俊峰[1] 韦华[1] 李京倖[1] 于洋[1] LI Bo;WANG Liangshan;GU Chengxiong;LI Haitao;YANG Junfeng;WEI Hua;LI Jingxing(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科六病房,100029

出　　处：《心肺血管病杂志》2018年第6期538-541,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:本研究旨在探讨后桥血管远端吻合口支撑装置(DAS)对右冠状动脉严重病变患者的预后影响。方法:回顾性分析我院2013年5月至9月,右冠状动脉严重病变的患者100例,并分为单独冠状动脉旁路移植(OPCABG)组和OPCABG+DAS组,各组50例。结果:OPCABG组、OPCABG+DAS组后降支(PDA)静脉桥2年通畅率分别为74.0%、94.0%,两组比较,差异有统计学意义(P=0.006)。两组近期心绞痛缓解率并差异无统计学意义(80.0%vs.92.0%,P=0.62)。两组术后随访无死亡,且心脑血管不良事件发生率差异无统计学意义[(92.0±3.8)vs.(82.0±5.4)%,P=0.08]。在多元Logistic回归分析中,右冠状动脉弥漫性病变是PDA静脉桥闭塞的危险因素(OR=11.05,95%CI:2.14~57.12,P=0.004),而DAS(OR=0.04,95%CI:0.003~0.350,P=0.004、近端狭窄>75%(OR=0.05,95%CI:0.007~0.301,P=0.001)和男性((OR=0.05,95%CI:0.007~0.301,P=0.001)是保护因素。结论:桥血管远端吻合口支撑装置能提高静脉桥近期通畅率。对于右冠状动脉严重病变的患者,CABG+DAS可能是一种新的治疗选择。Objective： The aim of this study was to introduce the distal anastomoses support（ DAS）procedure and investigate the effect of DAS on patients with right coronary artery（ RCA） severe lesion. Methods： Between May and September 2013,100 patients with an RCA severe lesion who underwent isolated OPCABG（ CABG alone group,n = 50） or CABG with DAS for anastomoses of SVG-PDA（ CABG plus DAS group,n = 50） were evaluated retrospectively. Results： Patency rates of SVG-PDA at two years were significantly higher in the CABG plus DAS group compared to the CABG alone group（ 94. 0% vs. 74. 0%,P =0. 006）. However,there was no significant difference between the two groups with regard to freedom from MACCE at two years [（ 92. 0 ± 3. 8） % vs.（ 82. 0 ± 5. 4） %,P = 0. 08]. No death occurred in both groups,and freedom from angina at two years did not differ significantly between two groups（ 80. 0% vs. 92. 0%,P =0. 62）. In multivariate logistic regression analysis,diffuse disease was the independent predictor of graft occlusion（ OR = 11. 05,95% CI： 2. 14-57. 12,P = 0. 004）,but concomitant DAS（ OR = 0. 04,95% CI： 0. 003-0. 350,P = 0. 004）,proximal stenosis 〉75%（ OR = 0. 09,95% CI： 0. 02-0. 50,P = 0. 006）,and male gender（ OR = 0. 05,95% CI： 0. 007-0. 301,P = 0. 001） were protective factors. Conclusion： Concomitant DAS could improve mid-term patency of SVG-PDA. Adding the DAS procedure to CAB may be a new choice for patients with an RCA severe lesion.

关 键 词：冠状动脉旁路移植术 吻合口远端支撑装置 桥血管通畅性 右冠状动脉严重病变 

分 类 号：R54[医药卫生—心血管疾病]