Background Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context.

Methods Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures.

Results A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac–cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan–Meier analysis revealed no significant survival disadvantage for SV group compared with RA group.

Conclusion CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.

背景 左乳内动脉 (LIMA) 和桡动脉 (RA) 之间的复合 T 型移植物是完全动脉心肌血运重建中的常见概念。本研究的目的是调查在这种情况下使用大隐静脉 (SV) 代替 RA 是否会产生相对较好的结果。

方法 2014 年初至 2019 年底在石勒苏益格-荷尔斯泰因大学医院心血管外科接受右冠状动脉或回旋动脉 T 型移植物或 SV 段心肌血运重建的患者基尔也包括在内。为了最大限度地减少手术差异，该部门仅由一名资深外科医生观察患者。排除标准是既往心脏手术、术前体外循环支持、非体外循环手术、额外的主动脉冠状动脉搭桥术和心脏联合手术。

结果 总共研究了 115 名患者。在 55 名患者中，T 形移植物放置在 LIMA 和 SV 之间，在 60 名患者中，T 形移植物放置在 LIMA 和 RA 之间。SV 组患者年龄较大（70.6 ± 7.8 岁 vs. 58.5 ± 10.0 岁；p  < 0.001），更常患有非 ST 抬高型心肌梗死（12.7% vs. 1.7%；p  = 0.027）、动脉高血压（83.6% vs. . 61.7%；p  = 0.009）和心房颤动（18.2 vs. 1.7%；p  = 0.003）。他们不太可能是主动吸烟者（16.4% vs. 38.3%；p  = 0.009），也不太可能有静脉曲张手术史（0 vs. 15.0%；p  = 0.003）。升主动脉钙化在隐动脉组中也更常见（18.2% vs. 3.3%，p  = 0.009）。两组之间的手术时间和远端吻合次数没有显着差异。术后谵妄（16.7% vs. 5.0%；p  = 0.043）在静脉患者中更为常见。腿部伤口愈合障碍（11.1 vs. 0%；p  = 0.011）仅发生在 SV 组中，手臂伤口感染仅发生在 RA 组中。74.8%的病例获得了完整随访。中位随访时间为 60.3 (39.6; 73.2) 个月。 随访时，两组之间的严重不良心脑事件（19.0% vs. 22.7%；p  = 0.675）和死亡率（14.5 vs. 6.7%；p = 0.167）没有显着差异。 仅在 RA 组中观察到心肌梗死（0 vs. 2.5%；p  = 1.000）和中风（0 vs. 7.5%；p = 0.245）。RA 组中单个患者需要经皮冠状动脉介入治疗（0 vs. 15.0%；p  = 0.028）。两组中均没有患者接受重复冠状动脉旁路移植术（CABG）。SV组患者有血管造影合格的移植物和开放吻合。RA 组中的一名患者注意到移植失败，在这种情况下，移植物和天然冠状血管都被支架固定。Kaplan-Meier 分析显示，与 RA 组相比，SV 组没有显着的生存劣势。

结论 LIMA 和 SV 段之间采用复合 T 形移植物的 CABG 可能与 LIMA 和 RA 之间采用复合 T 形移植物的搭桥手术相当。就中期观察期内的发病率和死亡率而言，这可能是正确的。我们的研究结果提出了这样的假设：不进行主动脉搭桥吻合术的决定可能比移植材料的选择更重要。