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Graft pathology at the time of harvest: impact on long-term survival / Patologia do enxerto no momento da coleta: impacto na sobrevida a longo prazo
Yuan, Shi-Min; Li, Yun; Ben, Yan Hong; Cheng, Xiao Feng; Li, Da Zhu; Li, De Min; Jing, Hua.
Affiliation
  • Yuan, Shi-Min; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
  • Li, Yun; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
  • Ben, Yan Hong; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
  • Cheng, Xiao Feng; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
  • Li, Da Zhu; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
  • Li, De Min; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
  • Jing, Hua; Fujian Medical University. Teaching Hospital. The First Hospital of Putian. Putian. CN
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;29(4): 543-551, Oct-Dec/2014. tab, graf
Article в En | LILACS | ID: lil-741726
Ответственная библиотека: BR1.1
ABSTRACT

Objective:

This study aims to present the graft pathology at the time of harvest and its impact on long-term survival.

Methods:

The remnants of the bypass grafts from 66 consecutive patients with coronary artery disease receiving a coronary artery bypass grafting were investigated pathologically, and pertinent predictive risk factors and survival were analyzed.

Results:

Medial degenerative changes with or without intimal proliferation were present in 36.8%, 37.8% and 35.6% of left internal mammary artery (IMA), radial artery and saphenous vein grafts. There were 2 (3.0%) hospital deaths and 9 (14.1%) late deaths. Multinomial logistic regression revealed left IMA pathological changes, dyslipidemia, history of percutaneous transluminal coronary angioplasty/stent deployment and Y-graft were significant predictive risk factors negatively influencing the patients’ long-term survival. Kaplan-Meier survival analysis revealed that the long-term survival of patients with left IMA pathological changes were significantly reduced compared with those without (74.1% vs. 91.4%, P=0.002); whereas no differences were noted in long-term survivals between patients with and without pathological changes of the radial arterial or saphenous vein grafts.

Conclusion:

Pathological changes may be seen in the bypass graft at the time of harvest. The subtle ultrastructural modifications and the expressions of vascular tone regulators might be responsible for late graft patency. The pathological changes of the left IMA at the time of harvest rather than those of the radial artery or saphenous vein graft affect significantly longterm survival. Non-traumatic maneuver of left IMA harvest, well-controlled dyslipidemia and avoidance of using composite grafts can be helpful in maintaining the architecture of the grafts. .
RESUMO

Objetivo:

Este estudo tem como objetivo apresentar a patologia do enxerto no momento da coleta e do impacto na sobrevida a longo prazo.

Métodos:

Os remanescentes de pontes de safena de 66 pacientes consecutivos com doença arterial coronária que receberam uma cirurgia de revascularização coronariana foram investigados patologicamente, e os fatores de risco preditivos e a sobrevivência foram analisados.

Resultados:

Alterações degenerativas da artéria medial, com ou sem proliferação da íntima estavam presentes em 36,8%, 37,8% e 35,6% de pontes da artéria torácica interna esquerda (ATIE), artéria radial e veia safena. Houve dois (3,0%) óbitos hospitalares e nove (14,1%) óbitos tardios. A regressão logística multinomial revelou que alterações patológicas na ATIE, dislipidemia, história de angioplastia/stent implantação coronariana transluminal percutânea e Y-enxerto foram significativos fatores de risco preditivos que influenciam negativamente a sobrevivência a longo prazo dos pacientes. Análise de sobrevida de Kaplan- Meier revelou que a sobrevivência a longo prazo de pacientes com alterações patológicas da ATIE foi significativamente reduzida em comparação com aqueles sem (74,1% vs. 91,4%, P=0,002), considerando que não foram observadas diferenças na sobrevivência de longo prazo entre pacientes com e sem alterações patológicas dos enxertos da artéria radial ou de veia safena.

Conclusão:

As alterações patológicas podem se desenvolver na revascularização no momento da coleta. As modificações ultraestruturais sutis e as expressões de reguladores do tônus vascular podem ser responsáveis pela patência tardia do enxerto. As alterações patológicas da ATIE no momento da coleta, em vez do enxerto da artéria radial ou da veia safena, podem afetar significativamente a sobrevida de longo prazo. Manobra não traumática da ATIE na coleta, bom controle da dislipidemia e para evitar uso de enxertos compostos pode ser útil na manutenção da arquitetura dos enxertos. .
Тема - темы
Key words

Полный текст: 1 База данных: LILACS Основная тема: Saphenous Vein / Coronary Artery Disease / Coronary Artery Bypass / Radial Artery / Tissue and Organ Harvesting / Mammary Arteries Тип исследования: Etiology_studies / Prognostic_studies / Risk_factors_studies Пределы темы: Aged / Aged80 / Female / Humans / Male Язык: En Журнал: Rev. bras. cir. cardiovasc Тематика журнала: CARDIOLOGIA / CIRURGIA GERAL Год: 2014 Тип: Article

Полный текст: 1 База данных: LILACS Основная тема: Saphenous Vein / Coronary Artery Disease / Coronary Artery Bypass / Radial Artery / Tissue and Organ Harvesting / Mammary Arteries Тип исследования: Etiology_studies / Prognostic_studies / Risk_factors_studies Пределы темы: Aged / Aged80 / Female / Humans / Male Язык: En Журнал: Rev. bras. cir. cardiovasc Тематика журнала: CARDIOLOGIA / CIRURGIA GERAL Год: 2014 Тип: Article