Markwirth T, Hennen B, Scheller B, Schäfers H J, Wendler O
Department of Cardiology, University Hospitals Homburg/Saar, Germany.
Ann Thorac Surg. 2001 Mar;71(3):788-93. doi: 10.1016/s0003-4975(00)01808-7.
The T-graft procedure achieves complete arterial revascularization in coronary three-vessel disease. In this technique, all bypass anastomoses are supplied by the left internal mammary artery (IMA). This prospective study explores the question of whether the quantitative flow in such grafts is influenced by the pathology in the native coronary arteries.
Eighty-two patients with coronary three-vessel disease were studied after complete arterial coronary revascularization with T-grafts. Quantitative flow and coronary flow reserve were measured in the proximal IMA with a Doppler guide wire. Three groups were compared: group 1, all native coronary arteries were stenosed but patent (n = 31); group 2, one occluded native coronary vessel (n = 33); group 3, two or more occluded native coronary arteries (n = 18).
Quantitative flow was significantly higher in group 3 than in group 2 at 1 week (93.9 +/- 39.5 vs 75.8 +/- 27.3 mL/min, p < 0.05) and 6 months postoperatively (86.0 +/- 40.1 vs. 69.1 +/- 35.5 mL/min, p < 0.05). Flow in group 2 was significantly (p < 0.05) higher than in group 1 (1 week: 58.0 +/- 28.4 mL/min, 6 months: 55.2 +/- 29.2 mL/min) in both examinations. There were no significant differences in coronary flow reserve between the three groups (1: 2.88 +/- 0.97, 2: 2.84 +/- 0.96, 3: 2.74 +/- 0.94).
After complete arterial revascularization with T-grafts, the quantitative flow in the IMA is influenced by the status of the native coronary arteries. As a result of competitive flow phenomena, blood flow in the bypasses is significantly lower when the coronary arteries are affected only by stenosis.
T形移植手术可实现冠状动脉三支血管病变的完全动脉血运重建。在该技术中，所有旁路吻合均由左乳内动脉（IMA）供血。这项前瞻性研究探讨了此类移植物中的定量血流是否受自身冠状动脉病变影响的问题。
对82例行T形移植完全动脉冠状动脉血运重建术后的冠状动脉三支血管病变患者进行研究。使用多普勒导丝测量IMA近端的定量血流和冠状动脉血流储备。比较三组：第1组，所有自身冠状动脉均狭窄但通畅（n = 31）；第2组，一支自身冠状动脉闭塞（n = 33）；第3组，两支或更多支自身冠状动脉闭塞（n = 18）。
第3组术后1周（93.9±39.5 vs 75.8±27.3 mL/分钟，p < 0.05）和6个月时（86.0±40.1 vs. 69.1±35.5 mL/分钟，p < 0.05）的定量血流显著高于第2组。在两次检查中，第2组的血流均显著高于第1组（1周：58.0±28.4 mL/分钟，6个月：55.2±29.2 mL/分钟）（p < 0.05）。三组之间的冠状动脉血流储备无显著差异（第1组：2.88±0.97，第2组：2.84±0.96，第3组：2.74±0.94）。
采用T形移植进行完全动脉血运重建后，IMA中的定量血流受自身冠状动脉状况的影响。由于竞争性血流现象，当冠状动脉仅受狭窄影响时，旁路中的血流显著降低。
