动脉化冠状动脉旁路移植术的应用现状

The state of the art for arterial coronary artery bypass grafting

旁路血管的选择一直是冠状动脉外科领域的热点。动脉旁路血管具有优良的生物学特性和远期通畅率。近二十年的临床观察和随机临床研究结果显示,胸廓内动脉是"金标准"旁路血管。多支动脉和全动脉冠状动脉旁路移植术可明显改善患者的远期生存,但也存在一定的技术难度和手术风险。国内外学者大力提倡多支动脉或全动脉化冠状动脉旁路移植术,并形成了相应的指南和专家共识。我国的冠状动脉外科进入了质量提升阶段,随着循证医学证据不断积累,动脉化冠状动脉旁路移植术具有良好的应用前景。

The selection of conduit has always been one of the most perennially debated topic in the field of coronary artery bypass grafting(CABG).Arterial grafts have demonstrated excellent biological characteristics and long-term patency in CABG.Clinical observations and randomized clinical trials over the past two decades have shown that the internal thoracic artery is the gold standard graft.Multi-arterial and total-arterial CABG significantly improves patients′long-term survival,but there are technical challenges and concerns of sternal complication.Currently multi-arterial and total-arterial CABG are strongly advocated and increasingly applied worldwide.Several guidelines have been published and updated,as well as Chinese expert consensus.Coronary surgery in China is paving anupper stage of quality improvement.Arterial coronary artery bypass grafting should be carried out more broadly in China as evidence accumulation and excellent long-term clinical results.