VanHimbergen D J, Koenig S C, Jaber S F, Cerrito P B, Spence P A
Department of Surgery, Jewish Hospital Heart and Lung Institute, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Heart Surg Forum. 1999;2(3):226-9.
Anastomotic quality is a critical issue in minimally invasive coronary artery bypass surgery, particularly "off-pump". It is important to detect a "poor" anastomosis during the procedure so future re-operation can be avoided. Methods such as intraoperative angiography, thermal angiography, probing of the anastomosis, and graft flow measurement have been used intraoperatively to help identify anastomotic errors. With the evolution of stabilizers, graft patency rates for off-pump cases have improved, but many believe they are still not as high as those of the conventional procedure. For off-pump surgery to be accepted and practiced universally, patency rates must be equivalent to those of "on-pump" cases. Transit-time flow measurement has become an increasingly popular non-invasive method for assessing anastomotic quality. However, it is difficult to establish whether an anastomosis is patent based on mean graft flow alone. Spectral analysis of graft flow waveforms reveal characteristic patterns that identify intermediate ranges of stenosis between fully patent and totally occluded. Together, these two components of graft flow have been used in the construction of a neural network to help identify "faulty" anastomoses. Transit-time flow measurement is a non-invasive tool that can be beneficial in identifying fully patent or nearly occluded grafts, and may also help in distinguishing intermediate stenoses.
吻合质量是微创冠状动脉旁路移植手术中的一个关键问题，尤其是“非体外循环”手术。在手术过程中检测到“不良”吻合口很重要，这样可以避免未来的再次手术。诸如术中血管造影、热血管造影、吻合口探查和移植物血流测量等方法已在术中用于帮助识别吻合口错误。随着稳定器的发展，非体外循环病例的移植物通畅率有所提高，但许多人认为其仍不如传统手术高。为了使非体外循环手术被普遍接受和应用，通畅率必须与“体外循环”病例相当。通过时间血流测量已成为一种越来越受欢迎的评估吻合质量的非侵入性方法。然而，仅基于平均移植物血流很难确定吻合口是否通畅。移植物血流波形的频谱分析揭示了识别完全通畅和完全闭塞之间狭窄中间范围的特征模式。移植物血流的这两个组成部分一起被用于构建神经网络，以帮助识别“有缺陷的”吻合口。通过时间血流测量是一种非侵入性工具，有助于识别完全通畅或几乎闭塞的移植物，也可能有助于区分中间狭窄。
