fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2023-8-3-80-92fcmedicine-759Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHДисфункция различных морфофункциональных систем «кондуит-артерия» после коронарного шунтированияSingle or multiple arterial grafting to design a coronary bypass: a retrospective studyhttps://orcid.org/0000-0002-1746-8895ФроловА. В.FrolovA. V.

Фролов Алексей Витальевич - кандидат медицинских наук, сердечно-сосудистый хирург, старший научный сотрудник лаборатории рентгенэндоваскулярной и реконструктивной хирургии сердца и сосудов.

650002, Кемерово, Сосновый бульвар, д. 6

Alexey V. Frolov - MD, PhD, Cardiovascular Surgeon, Senior Researcher, Laboratory of Endovascular and Reconstructive Surgery, Research Institute for Complex Issues of Cardiovascular Diseases.

6, Sosnovy Boulevard, Kemerovo, 650002

kjerne@yandex.ruhttps://orcid.org/0000-0003-3539-0291ЗагородниковН. И.ZagorodnikovN. I.

Загородников Никита Игоревич - сердечно-сосудистый хирург отделения нейрохирургии.

650002, Кемерово, Сосновый бульвар, д. 6

Nikita I. Zagorodnikov - MD, Cardiovascular Surgeon, Neurosurgery Unit, Kuzbass Clinical Cardiological Dispensary.

6, Sosnovy Boulevard, Kemerovo, 650002

https://orcid.org/0000-0003-3882-709XТарасовР. С.TarasovR. S.

Тарасов Роман Сергеевич - доктор медицинских наук, сердечно-сосудистый хирург, заведующий лабораторией рентгенэндоваскулярной и реконструктивной хирургии сердца и сосудов.

650002, Кемерово, Сосновый бульвар, д. 6

Roman S. Tarasov - MD, DSc, Head of the Laboratory of Endovascular and Reconstructive Surgery, Research Institute for Complex Issues of Cardiovascular Diseases.

6, Sosnovy Boulevard, Kemerovo, 650002

https://orcid.org/0000-0001-8370-3083ГригорьевЕ. В.GrigorievE. V.

Григорьев Евгений Валерьевич - доктор медицинских наук, профессор, заместитель директора по научной и лечебной работе.

650002, Кемерово, Сосновый бульвар, д. 6

Evgeny V. Grigoriev - MD, DSc, Professor, Chief Scientific Officer, Research Institute for Complex Issues of Cardiovascular Diseases.

6, Sosnovy Boulevard, Kemerovo, 650002

ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian FederationГБУЗ «Кузбасский клинический кардиологический диспансер имени академика Л.С. Барбараша»РоссияKuzbass Clinical Cardiological DispensaryRussian Federation202329092023838092Copyright © Фролов А.В., Загородников Н.И., Тарасов Р.С., Григорьев Е.В., 20232023Фролов А.В., Загородников Н.И., Тарасов Р.С., Григорьев Е.В.Frolov A.V., Zagorodnikov N.I., Tarasov R.S., Grigoriev E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/759Цель

Цель. Провести анализ причин и связанных с ними механизмов дисфункции различных морфофункциональных систем (МФС) «кондуит-артерия» после коронарного шунтирования (КШ) в отдалённом периоде наблюдения.

Материал и методы

Материал и методы. Методом простого визуального анализа оценены 102 ангиограммы, полученные в отдалённом послеоперационном периоде в ходе проведения коронарной шунтографии (КШГ) больным, подвергшимся ранее прямой реваскуляризации миокарда в виде КШ по поводу ишемической болезни сердца (ИБС). Проведён анализ дисфункций МФС «кондуит-артерия» в зависимости от коронарной позиции и используемых кондуитов, установлены их причины и вероятные механизмы в сроки свыше 10 лет наблюдения.

Результаты

Результаты. В ходе изучения 102 послеоперационных ангиограмм было выявлено, что среди 323 анализируемых МФС «кондуит-артерия» нормально функционирующие системы составили 230 (71,2%), а количество дисфункций систем в виде стенозов и окклюзий шунтов, а также различных изменений в КА, сопряжённых с этими состояниями, - 93 (28,8%). Наиболее частой причиной для систем ЛВГА-ПНА, ЛВГА-ДВ, ПВГА-ПНА, ПВГА-ПКА оказалось наличие конкурентного кровотока, ЛВГА-ВТК - плохое дистальное русло, ПВГА-ВТК - прогрессирование атеросклероза (АС) и плохое дистальное русло, БПВ-ДВ, БПВ-ВТК, БПВ-ПКА - плохое дистальное русло, а также дегенерация шунта, ЛА-ВТК и ЛА-ПКА - плохое дистальное русло, конкурентный кровоток и дегенерация шунта. В 5 (5,4%) случаев причина дисфункций не была установлена.

Выводы

Выводы. Доказано, что основными причинами и связанными с ними последующими механизмами дисфункций МФС «кондуит-артерия» с использованием ЛВГА и ПВГА является конкурентный кровоток, в то время как для систем с БПВ наличие плохого дистального коронарного русла.

Aim

Aim. To compare the efficiency of single arterial grafting (SAG) and multiple arterial grafting (MAG) at coronary artery bypass graft (CABG) surgery in the long term.

Material and Methods

Material and Methods. To assess the angiographic outcomes, we evaluated the patency of 323 bypasses at 102 angiograms obtained during coronary angiography performed > 10 years post-CABG surgery.

Results

Results. Out of 323 analyzed bypasses, 230 (71.2%) showed physiological functioning, whereas stenosis, occlusions, and other coronary artery alterations were found in 93 (28.8%) bypasses. The most common cause for the failure of anastomoses was competitive flow (most frequently registered in the anastomoses between left internal thoracic artery and left anterior descending artery, left internal thoracic artery and diagonal branches of left anterior descending artery, right internal thoracic artery and left anterior descending artery, and between right internal thoracic artery and right coronary artery), poor distal bed (most frequently revealed in the anastomosis between left internal thoracic artery and obtuse marginal artery, saphenous vein and diagonal branches of left anterior descending artery, saphenous vein and obtuse marginal artery, and between saphenous vein and right coronary artery), progression of atherosclerosis in combination with poor distal bed (most frequently detected in the anastomosis between right internal thoracic artery and obtuse marginal artery), and combination of poor distal bed, competitive flow, and graft degeneration (most frequently found in the anastomoses between radial artery and obtuse marginal artery and between radial artery and right coronary artery). In 5 (5.4%) cases, the cause of coronary bypass dysfunction was unclear.

Conclusion

Conclusion. The main causes for the coronary bypass failure included competitive flow (in case with multiple arterial grafting) and poor distal bed (in case with single arterial grafting).

дисфункцияшунткоронарные артерииморфофункциональная система «кондуит-артерия»коронарное шунтированиеcoronary artery bypass graft surgerycoronary angiographybypass dysfunctionsingle arterial graftingmultiple arterial graftingReferencesHwang H.Y., Paeng J.C., Kang J., Jang M.J., Kim K.B. Relation between functional coronary artery stenosis and graft occlusion after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 2021;161(3):1010-1018.e1. https://doi.org/10.1016/j.jtcvs.2020.11.072Hwang HY, Paeng JC, Kang J, Jang MJ, Kim KB. Relation between functional coronary artery stenosis and graft occlusion after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2021;161(3):1010-1018.e1. https://doi.org/10.1016/j.jtcvs.2020.11.072Limanto D.H., Chang H.W., Kim D.J., Kim J.S., Park K.H., Lim C. Coronary artery size as a predictor of Y-graft patency following coronary artery bypass surgery. Medicine (Baltimore). 2021;100(2):e24063. https://doi.org/10.1097/MD.0000000000024063Limanto DH, Chang HW, Kim DJ, Kim JS, Park KH, Lim C. Coronary artery size as a predictor of Y-graft patency following coronary artery bypass surgery. Medicine (Baltimore). 2021;100(2):e24063. https://doi.org/10.1097/MD.0000000000024063Фролов А.В. Морфофункциональная система «кондуит-артерия». Комплексные проблемы сердечно-сосудистых заболеваний. 2019;8(1):112-122. https://doi.org/10.17802/2306-1278-2019-8-1-112-122Frolov A.V. Morphological and functional system of graft-artery junctions. Complex Issues of Cardiovascular Diseases. 2019;8(1):112-122. (In Russ). https://doi.org/10.17802/2306-1278-2019-8-1-112-122Kraler S., Libby P., Evans P.C., Akhmedov A., Schmiady M.O., Reinehr M., Camici G.G., Luscher T.F. Resilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet Needs. Arterioscler. Thromb. Vasc. Biol. 2021;41:2237-2251. https://doi.org/10.1161/ATVBAHA.121.316256Kraler S, Libby P, Evans PC, Akhmedov A, Schmiady MO, Reinehr M, Camici GG, Luscher TF. Resilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet Needs. Arterioscler Thromb Vasc Biol. 2021;41:2237-2251. https://doi.org/10.1161/ATVBAHA.121.316256Dogan P., Kuyumcu M.S., Demiryapan E., Arisoy F., Ozeke J. Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice? Int. J. Angiol. 2017;26:27-31. https://doi.org/10.1055/s-0036-1587695Dogan P, Kuyumcu MS, Demiryapan E, Arisoy F, Ozeke J. Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice? Int J Angiol. 2017;26:27-31. https://doi.org/10.1055/s-0036-1587695Shishkova D., Markova V., Sinitsky M., Tsepokina A., Frolov A., Zagorodnikov N., Bogdanov L., Kutikhin A. Co-Culture of Primary Human Coronary Artery and Internal Thoracic Artery Endothelial Cells Results in Mutually Beneficial Paracrine Interactions. Int. J. Mol. Sci. 2020;21(21):8032. https://doi.org/10.3390/ijms21218032Shishkova D, Markova V, Sinitsky M, Tsepokina A, Frolov A, Zagorodnikov N, Bogdanov L, Kutikhin A. Co-Culture of Primary Human Coronary Artery and Internal Thoracic Artery Endothelial Cells Results in Mutually Beneficial Paracrine Interactions. Int J Mol Sci. 2020;21(21):8032. https://doi.org/10.3390/ijms21218032Doenst T., Sousa-Uva M. How to deal with nonsevere stenoses in coronary artery bypass grafting - a critical perspective on competitive flow and surgical precision. Curr. Opin. Cardiol. 2022;37(6):468-473. https://doi.org/10.1097/HCO.0000000000000993Doenst T, Sousa-Uva M. How to deal with nonsevere stenoses in coronary artery bypass grafting - a critical perspective on competitive flow and surgical precision. Curr Opin Cardiol. 2022;37(6):468-473. https://doi.org/10.1097/HCO.0000000000000993Borovic M.M.L., Lalic I.M., Borovic S.D., Zaletel I.V., Mutavdzin S.S., Bajcetic M.I., Kostic J.V., Trifunovicet Z.Z. Structural features of arterial grafts important for surgical myocardial revascularization: Part I - Histology of the internal thoracic artery. Vojnosanit. Pregl. 2015;72(10):914-921. https://doi.org/10.2298/VSP140515079LBorovic MML, Lalic IM, Borovic SD, Zaletel IV, Mutavdzin SS, Bajcetic MI, Kostic JV, Trifunovicet ZZ. Structural features of arterial grafts important for surgical myocardial revascularization: Part I - Histology of the internal thoracic artery. Vojnosanit Pregl. 2015;72(10):914-921. https://doi.org/10.2298/VSP140515079LFonseca D.A.,Antunes P.E.,Antunes M.J., Cotrim M.D. Histomorphometric analysis of the human internal thoracic artery and relationship with cardiovascular risk factors. PLoS ONE. 2019;14(1):e0211421. https://doi.org/10.1371/journal.pone.0211421Fonseca DA, Antunes PE, Antunes MJ, Cotrim MD. Histomorphometric analysis of the human internal thoracic artery and relationship with cardiovascular risk factors. PLoS ON. 2019;14(1):e0211421. https://doi.org/10.1371/journal.pone.0211421Xenogiannis I., Zenati M., Bhatt D.L., Rao S.V., Rodes-Cabau J., Goldman S., Shunk K.A., Mavromatis K., Banerjee S., Alaswad K., Nikolakopoulos I., Vemmou E., Karacsonyi J., Alexopoulos D., Burke M.N., Bapat V.N., Brilakis E.S. Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation. 2021;144(9):728-745. https://doi.org/10.1161/CIRCULATIONAHA.120.052163Xenogiannis I, Zenati M, Bhatt DL, Rao SV, Rodes-Cabau J, Goldman S, Shunk KA, Mavromatis K, Banerjee S, Alaswad K, Nikolakopoulos I, Vemmou E, Karacsonyi J, Alexopoulos D, Burke MN, Bapat VN, Brilakis ES. Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation. 2021;144(9):728-745. https://doi.org/10.1161/CIRCULATIONAHA.120.052163Zhu Y.Y., Hayward P.A., Hare D.L., Reid C., Stewart A.G., Buxton B.F. Effect of lipid exposure on graft patency and clinical outcomes: arteries and veins are different. Eur. J. Cardiothorac. Surg. 2014;45(2):323-328. https://doi.org/10.1093/ejcts/ezt261Zhu YY, Hayward PA, Hare DL, Reid C, Stewart AG, Buxton BF. Effect of lipid exposure on graft patency and clinical outcomes: arteries and veins are different. Eur J Cardiothorac Surg. 2014;45(2):323-328. https://doi.org/10.1093/ejcts/ezt261Duanmu Z., Chen W., Gao H., Yang X., Luo X., Hill N.A. A One-Dimensional Hemodynamic Model of the Coronary Arterial Tree. Front. Physiol. 2019;10:853. https://doi.org/10.3389/fphys.2019.00853Duanmu Z, Chen W, Gao H, Yang X, Luo X, Hill NA. (2019) A One-Dimensional Hemodynamic Model of the Coronary Arterial Tree. Front Physiol. 2019;10:853. https://doi.org/10.3389/fphys.2019.00853Li J., Liu R., Ji X., Xue H., Zhang G., Wang C., Chen Q., Xue F., Cui L. Insight into the Spectrum of Coronary Atherosclerosis in Asymptomatic Urban Han Chinese Population by Coronary Computed Tomography Angiography. PLoS ONE. 2015;10(7):e0132188. https://doi.org/10.1371/journal.pone.0132188Li J, Liu R, Ji X, Xue H, Zhang G, Wang C, Chen Q, Xue F, Cui L. (2015) Insight into the Spectrum of Coronary Atherosclerosis in Asymptomatic Urban Han Chinese Population by Coronary Computed Tomography Angiography. PLoS ONE. 2015;10(7):e0132188. https://doi.org/10.1371/journal.pone.0132188Giannoglou G.D., Antoniadis A.P., Chatzizisis Y.S., Louridas G.E. Difference in the topography of atherosclerosis in the left versus right coronary artery in patients referred for coronary angiography. BMC Cardiovas. Disord. 2010;10:26. https://doi.org/10.1186/1471-2261-10-26Giannoglou GD, Antoniadis AP, Chatzizisis YS, Louridas GE Difference in the topography of atherosclerosis in the left versus right coronary artery in patients referred for coronary angiography. BMC Cardiovascular Disorders. 2010;10:26. https://doi.org/10.1186/1471-2261-10-26Chatzizisis Y.S., Giannoglou G.D., Parcharidis G.E., Louridas G.E. Is left coronary system more susceptible to atherosclerosis than right? A pathophysiological insight. Int. J. Cardiol. 2007;116(1):7-13. https://doi.org/10.1016/j.ijcard.2006.03.029Chatzizisis YS, Giannoglou GD, Parcharidis GE, Louridas GE. Is left coronary system more susceptible to atherosclerosis than right? A pathophysiological insight. Intern J Cardiology. 2007;116(1):7-13. https://doi.org/10.1016/j.ijcard.2006.03.029Fiddicke M., Fleissner F., Brunkhorst T., Kuhn E.M., Obed D., Boethig D., Ismail I., Haverich A., Warnecke G., Sommer W. Coronary artery bypass grafts to chronic occluded right coronary arteries. JTCVS Open. 2021;7:169-179. https://doi.org/10.1016/j.xjon.2021.06.007Fiddicke M, Fleissner F, Brunkhorst T, Kuhn EM, Obed D, Boethig D, Ismail I, Haverich A, Warnecke G, Sommer W. Coronary artery bypass grafts to chronic occluded right coronary arteries. JTCVS Open. 2021;7:169-179. https://doi.org/10.1016/j.xjon.2021.06.007McKavanagh P., Yanagawa B., Zawadowski G., Cheema A. Management and Prevention of Saphenous Vein Graft Failure: A Review. Cardiol. Ther. 2017;6(2):203-223. https://doi.org/10.1007/s40119-017-0094-6McKavanagh P, Yanagawa B, Zawadowski G, Cheema A. Management and Prevention of Saphenous Vein Graft Failure: A Review. Cardiol Ther. 2017;6(2):203-223. https://doi.org/10.1007/s40119-017-0094-6Hosono M., Murakami T., Hirai H., Sasaki Y., Suehiro S., Shibata T. The Risk Factor Analysis for the Late Graft Failure of Radial Artery Graft in Coronary Artery Bypass Grafting. Ann. Thorac. Cardiovasc. Surg. 2019;25(1):32-38. https://doi.org/10.5761/atcs.oa.18-00054Hosono M, Murakami T, Hirai H, Sasaki Y, Suehiro S, Shibata T. The Risk Factor Analysis for the Late Graft Failure of Radial Artery Graft in Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg. 2019;25(1):32-38. https://doi.org/10.5761/atcs.oa.18-00054Gaudino M., Antoniades C., Benedetto U., Deb S., Di Franco A., Di Giammarco G., Fremes S., Glineur D., Grau J., He G.W., Marinelli D., Ohmes L.B., Patrono C., Puskas J., Tranbaugh R., Girardi L.N., Taggart D.P.; ATLANTIC (Arterial Grafting International Consortium) Alliance. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation. 2017;136(18):1749-1764. https://doi.org/10.1161/CIRCULATIONAHA.117.027Gaudino M, Antoniades C, Benedetto U, Deb S, Di Franco A, Di Giammarco G, Fremes S, Glineur D, Grau J, He GW, Marinelli D, Ohmes LB, Patrono C, Puskas J, Tranbaugh R, Girardi LN, Taggart DP; ATLANTIC (Arterial Grafting International Consortium) Alliance. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation. 2017;136(18):1749-1764. https://doi.org/10.1161/CIRCULATIONAHA.117.02.

The authors declare that there are no conflicts of interest present.