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Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease:: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting

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AMERICAN HEART JOURNAL 2001年第4期142卷 563-570页

作者： de Cannière, D Jansens, JL Goldschmidt-Clermont, P Barvais, L Decroly, P Stoupel, E Erasme Univ Hosp Dept Cardiac Surg B-1070 Brussels Belgium Erasme Univ Hosp Dept Anesthesiol B-1070 Brussels Belgium Erasme Univ Hosp Dept Invas Cardiol B-1070 Brussels Belgium Duke Univ Hosp Div Cardiol Durham NC USA

Objective Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. Methods Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. Results All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which For restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. Conclusions We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.

关键词：血管成形术经腔经皮冠状动脉/方法心肺转流术综合疗法冠状血管造影术/统计学和数值数据冠状动脉分流术/方法冠心病/诊断冠心病/外科学冠心病/治疗随访研究移植物闭塞血管/诊断移植物闭塞血管/流行病学健康状况胸廓内动脉-冠状动脉吻合术/方法疼痛测定试点项目生活质量问卷调查治疗结果老年人女(雌)性人类男(雄)性中年人

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Stents covered by autologous venous grafts: Feasibility and immediate and long-term results

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AMERICAN HEART JOURNAL 2000年第3期139卷 437-445页

作者： Stefanadis, C Toutouzas, K Tsiamis, E Vlachopoulos, C Kallikazaros, I Stratos, C Vavuranakis, M Toutouzas, P Univ Athens Hippokrat Hosp Dept Cardiol GR-10679 Athens Greece

Background Previous experimental studies with a new covered stent, the autologous venous graft-covered stent (AVGCS), have shown favorable results. The aim of this study was to evaluate the feasibility and safety of this new technique in human coronary arteries and to compare the long-term outcome with uncovered stents. Methods and Results A venous graft was removed from an upper limb. A conventional stent then was covered by the venous graft. Fifty-eight AVGCS were implanted in 56 patients, including 16 patients with acute coronary syndromes (ACS). Additionally, in 114 patients, 138 uncovered stents were implanted, serving as a control group, including 38 patients with ACS, The procedure was successful in all patients. Stent thrombosis was observed in 3 patients in the control group and in 1 patient with an AVGCS. There was a trend for the minimal luminal diameter to be greater in the AVGCS group at follow-up (P = .07), and statistical significance was observed in patients with ACS (P < .01). The target vessel revascularization and the restenosis rates were similar between the 2 groups. In patients with ACS, the restenosis rate was less (P < .04) and there was a trend for target vessel revascularization to be less in covered stents (P = .09). The event-free survival rate at 4 years was 85% in the AVGCS group versus 81% in the control group (P = not significant);in ACS it was 94% versus 78%, respectively (P = not significant). Stents covered by thicker venous grafts were associated with improved clinical outcome. Conclusions stents covered by autologous venous grafts may be safely prepared without complications. This technique may prove to be a useful means, especially in patients with ACS.

关键词：冠状血管造影术冠心病/外科学冠状血管/外科学无病生存可行性研究随访研究移植物闭塞血管/诊断移植物闭塞血管/流行病学心肌血管重建术/方法危险性评估支架血栓形成/诊断血栓形成/流行病学移植自体治疗结果静脉/移植女(雌)性人类男(雄)性中年人

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Incidence and risk factors predictive of unstable angina resulting from restenosis after percutaneous angioplasty of saphenous vein grafts

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AMERICAN HEART JOURNAL 2000年第6期140卷 827-833页

作者： Chandrasekar, B Bourassa, MG Montreal Heart Inst Res Ctr Montreal PQ H1T 1C8 Canada Vijaya Heart Fdn Vijaya Hosp Chennai India

Background The current study was designed to determine the incidence and risk factors for unstable angina resulting from restenosis in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) of saphenous vein graft (SVG), about which little data ore available. Methods and Results A retrospective analysis of a consecutive series of 212 patients undergoing PTCA of SVG was performed. Procedural success was achieved in 200 patients (94.3%) who formed the study group. During a follow-up of 16.8 +/- 10.2 months, 24.5% of patients presented with unstable angina resulting from restenosis. There was a higher prevalence of dyslipidemia (81.6% vs 51.2%, P<.0002) and greeter postprocedural residual stenosis (14.2% +/- 12.6% vs 7.1% +/- 11.0%, P =.007) in patients with unstable angina caused by restenosis compared with the remaining patient population. By multivariate analysis, dyslipidemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.64-8.39, P<.002) and to a lesser extent postprocedural residual stenosis (OR 1.04, 95% CI 1.01-1.07, P<.05) were predictive of unstable angina resulting from restenosis. Among dyslipidemic patients, those not on lipid-lowering drugs during the index procedure had a significantly higher incidence of unstable angina caused by restenosis than did those on lipid-lowering drugs (P<.05). Conclusion Unstable angina caused by restenosis presents in as many as ore fourth of patients undergoing PTCA of SVG, Dyslipidemia strongly, and to a lesser extent postprocedural residual stenosis, predicts its occurrence, Scrupulous attention to these modifiable risk factors may help reduce the incidence of unstable angina after SVG angioplasty.

关键词：心绞痛不稳定型/流行病学心绞痛不稳定型/病因学心绞痛不稳定型/治疗血管成形术经腔经皮冠状动脉降血脂药/治疗应用移植物闭塞血管/并发症移植物闭塞血管/流行病学高脂血症/并发症高脂血症/药物疗法高脂血症/流行病学发病率比值比预后魁北克/流行病学复发回顾性研究危险因素隐静脉/移植治疗失败成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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The predictive value of intraoperative duplex for early vein graft patency in lower extremity revascularization

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ANNALS OF VASCULAR SURGERY 1999年第3期13卷 275-283页

作者： MacKenzie, KS Hill, AB Steinmetz, OK McGill Univ Div Vasc Surg Montreal PQ Canada

This study was undertaken to evaluate the ability of intraoperative duplex scanning during infrainguinal vein bypass to identify technical abnormalities and to determine the relation between intraoperative scan result and early primary graft patency. We retrospectively reviewed of 78 consecutive intraoperative duplex scans for infrainguinal vein bypass that were performed between October 1993 and October 1996 during the course of infrainguinal vein bypass. Duplex scans were classified as normal or abnormal based on B-mode image and/or Doppler velocity spectra. Grafts were grouped according to duplex findings and intraoperative action: group I, normal intraoperative scan;group II, abnormal intraoperative scan, revised;group III, abnormal intraoperative scan, not revised. The relationship of intraoperative duplex scan findings to intraoperative graft revision to 1-month and 6-month primary graft patency by life table was analyzed. The analysis demonstrates that the results of intraoperative duplex scans can be used to identify grafts at low risk for early postoperative graft failure (groups I and II), and those at high risk for early postoperative graft failure (group III).

关键词：移植物闭塞血管/流行病学移植物闭塞血管/超声检查手术中护理缺血/外科学腿/血液供给寿命表试验预期值回顾性研究危险因素超声检查多普勒双功能血管未闭老年人女(雌)性人类男(雄)性

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A prospective evaluation of PTFE graft patency and surveillance techniques in hemodialysis access

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ANNALS OF VASCULAR SURGERY 1999年第2期13卷 191-198页

作者： Cinat, ME Hopkins, J Wilson, SE Univ Calif Irvine Irvine Med Ctr Dept Surg Orange CA 92868 USA

The purpose of this study was to perform a prospective multicenter evaluation of the patency, complications, and predictive factors of patency for 6-mm expanded polytetrafluoroethylene (ePTFE) grafts used in hemodialysis access. Eighty-six patients were evaluated;the mean age was 55.8 years (range 23-90), 46 patients were female. Patency and complications were assessed at the initial dialysis and 1, 3, 6, 9, and 12 months postoperatively. Kaplan-Meier survival curves were calculated to determine primary and secondary patency, and log-rank analysis was used to determine differences between curves. The Student's t-test was used to compare groups. Primary and secondary patency rates at 1 year were 43% and 64%. Venous line pressures tended to rise over time. Recirculation values and blood flow rates during dialysis showed no correlation to graft patency. These results show that ePTFE provides a suitable secondary choice for vascular access for end-stage renal disease patients in whom an autogenous fistula is not possible. Thrombosis and anastomotic stenosis are common and should be aggressively identified and treated to prolong overall graft survival.

关键词：动静脉转流术外科/仪器和设备人工血管移植物闭塞血管/诊断移植物闭塞血管/流行病学移植物存活聚四氟乙烯前瞻性研究肾透析/仪器和设备时间因素血管未闭女(雌)性人类男(雄)性中年人

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