桡动脉在高龄患者全动脉搭桥手术中的应用

Application of radial artery in total arterial coronary revascularization in elderly patients

目的总结桡动脉在高龄患者全动脉搭桥中的应用经验和临床效果。方法回顾分析2020年7月1日至2022年5月30日在香港大学深圳医院接受全动脉搭桥患者的临床资料。根据年龄将患者分为≥65岁组和<65岁组。所有患者均于术前超声评估桡动脉血流、管径、内膜完整性及Allen试验;术中留取桡动脉远端部分组织行病理检查;术后复查冠状动脉CT血管成像(CTA)并随访。总结分析桡动脉超声评估及桡动脉的应用对高龄患者全动脉搭桥的安全性和可靠性。结果共101例接受全动脉搭桥患者,其中年龄≥65岁35例,<65岁66例;使用双侧桡动脉患者78例,单侧桡动脉23例,因右侧桡动脉造影后闭塞而采用双侧乳内动脉4例。所有桡动脉近端均吻合于升主动脉近端,远端做"Y"型桥34例,序贯桥4例。患者术后均无院内死亡;无围手术期心血管事件;围手术期脑梗死3例;二次开胸止血1例;应用主动脉内球囊反搏(IABP)辅助21例;伤口愈合不良2例,经清创后愈合良好。出院后随访2~20个月,患者无乳内动脉闭塞,桡动脉闭塞4支;无主要不良心脑血管事件(MACCE)发生,生存率100%。以上围手术期并发症和随访终点事件,在<65岁和≥65岁两个年龄组中无显著性差异。结论通过调整搭桥吻合顺序及术前优化评估方式,桡动脉配合乳内动脉在全动脉搭桥中可以获得较好的近期效果,并且可以安全可靠地应用于高龄患者。

Objective To summarize the application experience and clinical effect of radial artery in total arterial coronary revascularization(TAR)in elderly patients.Methods Retrospectively analyzed the clinical data of patients who underwent TAR at the University of Hong Kong Shenzhen Hospital from July 1,2020 to May 30,2022.Patients were divided into≥65-year-old group and<65-year-old group according to age.The radial artery blood flow,diameter,intimal integrity and Allen test were evaluated by ultrasound before operation.The distal ends of radial artery were collected for pathological examination during operation.Coronary artery CT angiography(CTA)was examined postoperatively and follow up.The safety and reliability of ultrasonic assessment of radial artery and application of radial artery in elderly patients with TAR were summarized and analyzed.Results A total of 101 patients received TAR,including 35 cases aged≥65 years old,66 cases aged<65 years old;78 cases used bilateral radial arteries,and 23 cases used unilateral radial arteries.4 cases of bilateral internal mammary arteries.All the proximal ends of the radial artery were anastomosed to the proximal end of the ascending aorta,34 cases were performed of"Y"grafts,and 4 cases were sequential anastomoses.There was no in-hospital death and perioperative cardiovascular events.Perioperative cerebral infarction occurred in 3 patients.1 patients was reoperated for bleeding.Intra-aortic balloon pump(IABP)assistance was used in 21 patients.Poor wound healing occurred in 2 cases and healed well after debridement.Follow-up of 2 to 20 months after discharge showed no internal mammary artery occlusion and 4 radial artery occlusions;no major adverse cardiovascular and cerebrovascular event(MACCE)occurred,and the survival rate was 100%.There was no significant difference in the above perioperative complications and follow-up endpoints between the two age groups.Conclusion By adjusting the order of bypass anastomosis and optimizing the preoperative evaluation method,radial artery combined with internal mammary artery can obtain better outcome early in TAR,and can be safely and reliably applied to elderly patients.