摘要
背景:应用对称性旁路连接装置可在冠状动脉搭桥(CABG)术中迅速将隐静脉桥吻合到主动脉上,而不需对主动脉施行横形钳闭。先前针对该装置的非对照性研究发现在6个月时出现静脉桥闭塞,其可能的原因是新生内膜增生。方法和结果:为评估该Symmetry装置的长期临床效果,作者对从2002年1月1日至2003年12月31日期间在Duke医学中心接受CABG手术的患者进行了回顾性、配对、病例对照分析。
BACKGROUND -The Symmetry Bypass Connector(St. Jude Medical) was developed to rapidly anastomose saphenous vein grafts to the aorta during coronary bypass surgery(CABG) without cross-clamping. Previous uncontrolled studies of this device observed vein graft closures at six months, possibly attributable to neointimal hyperplasia. METHODS AND RESULTS -To assess the long-term clinical outcomes of the Symmetry device, we performed a retrospective matched case control analysis of patients who underwent CABG at Duke Medical Center between January 1, 2002 and December 31, 2003. In 121 patients, at least one proximal anastomosis used a Symmetry device. Traditional suture methods were used in 178 control patients, matched by age group, gender, use of cardiopulmonary bypass, and Hannan perioperative risk score. One-year outcomes were compared using the log-rank test and Cox proportional hazards regression models. Major adverse events were more frequent among cases compared with controls. By unadjusted Kaplan-Meier analysis for the composite end point of death, nonfatal myocardial infarction, repeat cardiac catheterization, or repeat CABG, there was a trend towards increased events in the Symmetry device group(P=0.053). No significant differences were detected for stroke, all cause mortality, or the combined end point of death or nonfatal myocardial infarction. CONCLUSIONS -Use of the Symmetry Bypass Connector was associated with increased risk for major adverse events at 1 year, suggestive of early graft closure. The potential reductions in operative stroke risk(from the elimination of aortic cross-clamping) must be weighed against the potential risk for later adverse events. These findings encourage close followup of patients who received this device.
