ﺗﺠﺮﺑﺔ 7 ﺳﺎﻟﻪ اﺳﺘﻔﺎده از ﺷﺮﻳﺎن رادﻳﺎل در ﺑﺎي ﭘﺲ ﻛﺮوﻧﺮ در ﻣﺮﻛﺰ ﻗﻠﺐ ﺷﻬﻴﺪ رﺟﺎﻳﻲ

7-Years Experience with Radial Artery Conduit in Coronary Artery bypass Graft in Rajaee Heart Center

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻣﻴـﺰﺍﻥ ﺑﺎﺯ ﺑﻮﺩﻥ ﮔـﺮﺍﻓﺖ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ، ﺩﺭ ﺑﺎﻱ ﭘﺲ ﮐـﺮﻭﻧﺮ، ﺣﺪﻭﺩ 80 ﺩﺭ ﻃﻲ 7 ﺳﺎﻝ ﻣﻲ ﺑﺎﺷﺪ. ﻫﺮ ﭼﻨﺪ ﺩﺭ ﻣﻘﺎﻻﺗﻲ، ﻧﺘﺎﻳﺞ ﺑﻬﺘـﺮ ﺍﺯ ﺍﻳﻦ ﻣﻴﺰﺍﻥ، ﺩﺭ ﻣﻮﺍﺭﺩ ﺗﻨﮕﻲ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﺩﺭﻗﺴﻤـﺖ ﭘﺮﻭﮐﺴﻴﻤﺎﻝ ﺑﺎ ﺭﺍﻥ ﺁﻑ )(Run-Off ﺧﻮﺏ ﮔﺰﺍﺭﺵ ﺷﺪﻩ ﺍﺳﺖ. ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺩﺭ ﺳﻴﺴﺘـﻢ ﭼﭗ ﻋـﺮﻭﻕ ﮐﺮﻭﻧﺮ، ﺑﺎ ﺭﺍﻥ ـ ﺁﻑ ﺧـﻮﺏ، ﺷﺮﻁ ﺍﺻﻠﻲ ﺑﺮﺍﻱ ﺑﺎﺯ ﻣﺎﻧﺪﻥ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﻣﻲ ﺑﺎﺷﺪ، ﻭ ﺩﺭ ﭼﻨﻴﻦ ﻣـﻮﺍﺭﺩﻱ ﻣﻴﺰﺍﻥ ﺑﺎﺯ ﻣﺎﻧﺪﻥ ﮔﺮﺍﻓﺖ ﺑﻴﺸﺘﺮ ﺍﺯ ﻣﻘـﺪﺍﺭ ﺫﮐـﺮ ﺷﺪﻩ ﺩﺭ ﺑﺎﻻ ﺍﺳﺖ. ﺩﺭ ﻣﻄﺎﻟﻌﺔ ﺯﻳﺮ ﻧﺘﺎﻳﺞ ﮐﻮﺗﺎﻩ ﻣﺪﺕ ﻭ ﻣﻴﺎﻥ ﻣﺪﺕ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺩﺭ ﻃﻲ 7 ﺳﺎﻝ ﻣـﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﺯ ﺳﺎﻝ 1378 ﺍﻟﻲ 1385، ﺗﻌﺪﺍﺩ 308 ﺑﺒﻤـﺎﺭ ﺑﺎﻱ ﭘﺲ ﮐـﺮﻭﻧﺮ ﮐﻪ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺩﺭ ﺁﻧﻬﺎ ﺍﺳﺘﻔـﺎﺩﻩ ﺷـﺪﻩ ﺑﻮﺩ، ﻣـﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. ﻗﺒﻞ ﺍﺯ ﺑﺮﺩﺍﺷﺘﻦ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺗﺴﺖ ﺁﻟﻦ ﺩﺭ ﻫﻤﻪ ﺑﻴﻤـﺎﺭﺍﻥ ﺍﻧﺠـﺎﻡ ﻣﻲ ﺷﺪ. ﻣﺘﻮﺳـﻂ ﺯﻣﺎﻥ ﭘﻴﮕﻴـﺮﻱ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ 21±6/2ﻣﺎﻩ ﺑـﻮﺩ. ﻧﺘﺎﻳﺞ ﮐـﻮﺗﺎﻩ ﻣـﺪﺕ ﻭ ﻣﻴـﺎﻥ ﻣﺪﺕ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷـﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﻭ ﻫﻤﭽﻨﻴـﻦ ﻋﻮﺍﺭﺽ ﺩﺭ ﺍﻳﻦ ﻋﺪﻩ ﺑﺮﺭﺳﻲ ﮔـﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺗﻌﺪﺍﺩ 308 ﺑﻴﻤـﺎﺭ )240 ﻣـﺮﺩ ﻭ 68 ﺯﻥ( ﺩﺭ ﺍﻳﻦ ﻣـﺪﺕ ﻭﺟـﻮﺩ ﺩﺍﺷﺖ، ﮐﻪ ﺣﺪﺍﻗﻞ ﻳﮏ )286 ﻧﻔﺮ( ﻳﺎ ﺩﻭ 22 ﻧﻔﺮ( ﺁﻧﺎﺳﺘﻮﻣﻮﺯ ﺩﻳﺴﺘﺎﻝ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺩﺭ ﺁﻧﻬﺎ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺑﻮﺩ. ﻣﺘﻮﺳﻂ ﺳﻦ ﺑﻴﻤﺎﺭﺍﻥ 55+4/8 )26 ﺗﺎ 78 ﺳﺎﻝ ﺑﻮﺩ. ﺣﺪﻭﺩ 96 ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺍﻟﮑﺘﻴﻮ ﻭ 4 ﺍﻭﺭﮊﺍﻧﺲ ﺑﻮﺩ. ﻣﺘﻮﺳﻂ ﺗﻌـﺪﺍﺩ ﮔـﺮﺍﻓﺖ 3/5 ﮔـﺮﺍﻓﺖ ﺩﺭ ﻫـﺮ ﺑﻴﻤـﺎﺭ ﺑﻮﺩ، ﺩﺭ 18 ﺑﻴﻤﺎﺭﺍﻥ ﺗﻨﻬﺎ ﮔﺮﺍﻓﺖ ﻫﺎﻱ ﺷﺮﻳﺎﻧﻲ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺑﻮﺩ. ﻣـﻮﺭﺑﻴﺪﻳﺘﻲ ﺍﻳﻦ ﺑﻴﻤـﺎﺭﺍﻥ ﻋﺒﺎﺭﺕ ﺑﻮﺩ ﺍﺯ: ﺧﻮﻧﺮﻳﺰﻱ ﻣﻨﺠـﺮ ﺑﻪ ﺟـﺮﺍﺣﻲ ﻣﺠﺪﺩ ﺩﺭ 2/2%، MI ﭘﺲ ﺍﺯ ﻋﻤﻞ ﺩﺭ 3/2%، ﭘﺎﺭﺳﺘﺰﻱ ﺩﺭ ﺩﺳﺖ ﺩﺭ 10%، ﺁﺑﺴﻪ ﻧﺎﺷﻲ ﺍﺯ ﺑﺨﻴﻪ ﺩﺭ 3/5 ﻣﺘﻮﺳﻂ ﺯﻣﺎﻥ ﮐﻼﻣﭗ ﺁﺋﻮﺭﺕ 46+9 ﺩﻗﻴﻘﻪ ﻭ ﻣﺘﻮﺳﻂ ﺯﻣﺎﻥ ﭘﻤﭗ 85+11 ﺩﻗﻴﻘﻪ ﺑﻮﺩ. ﻣﺮﮒ ﻭ ﻣﻴﺮ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ 2) %0/6 ﺑﻴﻤﺎﺭ( ﺑﻮﺩ ﮐﻪ ﺩﺭ ﻳﮑﻲ ﻣﺴﺘﻘﻴﻤﺎﹰ ﻣـﺮﺑﻮﻁ ﺑﻪ ﻋﺎﺭﺿﻪ ﺑﺮﺩﺍﺷﺘﻦ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺑﻮﺩ. ﺩﺭ ﺧﻼﻝ ﭘﻴﮕﻴﺮﻱ ﻫﻤﻪ ﺑﻴﻤﺎﺭﺍﻥ ﺯﻧﺪﻩ ﺑﻮﺩﻩ، ﺣﻮﺍﺩﺙ ﻗﻠﺒﻲ ﻧﺪﺍﺷﺘﻪ، ﻭ ﻋﻤﻠﮑـﺮﺩ ﻗﻠﺒﻲ ﺧﻮﺑﻲ ﺩﺍﺷﺘﻪ ﺍﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻧﺘﻴـﺠﺔ ﮐﻮﺗﺎﻩ ﻣـﺪﺕ ﻭ ﻣﻴـﺎﻥ ﻣـﺪﺕ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﺮﻳﺎﻥ ﺭﺍﺩﻳﺎﻝ ﺧﻮﺏ ﺑﻮﺩﻩ ﻭ ﺗﻮﺻﻴﻪ ﺑﻪ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺍﻳﻦ ﮔﺮﺍﻓﺖ ﺩﺭ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺑﺎﻱ ﭘﺲ ﮐـﺮﻭﻧﺮ ﺭاﺗﻮﺻﻴﻪ ﻣﻲ ﻧﻤﺎﻳﻴﻢ. ﭘﻴﺸﻨﻬﺎﺩ ﻣﻲ ﺷﻮﺩ ﻣﻄﺎﻟﻌﺎﺕ ﺁﻧﮋﻳﻮﮔﺮﺍﻓﻴﮏ ﺟﻬﺖ ﺑﺮﺭﺳﻲ ﻣﻴﺰﺍﻥ ﺑﺎﺯ ﺑﻮﺩﻥ ﮔﺮﺍﻓﺖ ﻫﺎ ﻧﻴﺰ ﺍﻧﺠﺎﻡ ﺷﻮﺩ.

Introduction & Objective: The patency rates of a radial artery graft for CABG approximate 80% at 7 years, although significantly higher patency rates have been reported. Placement of the radial artery graft onto a left-sided target vessel with a high-grade proximal stenosis and good runoff may result in higher patency rates. We evaluated radial artery as a suitable conduit for CABG and measured its early and mid-term results in our 5 years experience. Materials & Methods: From August 1999 to June 2006 radial artery graft was used for CABG in 308 patients. We never dilate radial artery with intraluminal injection. Early and mid term complications and clinical outcomes were evaluated in these patients with a mean follow up of 21±6.2 months. Allen test was performed before operation in all patients. Results: The number of 308 patients (240 male and 68 female) undergoing CABG had one (286) or two (22) distal anastomosis from radial graft conduit in addition to other conduits, patients’ mean age was 55±4.8 years (26-78). The number of 96% of the operations were elective and 4% were urgent. An average of 3.5 grafts per patient was performed. In 18% of the patients, total arterial conduit was used. The operative morbidity was re-operation for bleeding in 2.3%; post-operative-MI in 3.2%; paresthesis in the hand in 10%; stitch abscess in the hand in 3.5%. Mean x-time was 46±9 minutes and the mean CPB time was 85±11 minutes. Hospital mortality was in 0.6%( in 2 patients), in one case directly due to complication of harvesting of radial artery. During the follow up, all the patients are alive, free from cardiac events and have good function classes. Conclusions: Early and mid term results of CABG with radial artery conduit is excellent, and we recommend angiographic studies to establish the true long-term patency of radial artery