Kassab Ghassan S, Navia José A
Department of Biomedical Engineering, University of California, Irvine, California 92697-2715, USA.
Annu Rev Biomed Eng. 2006;8:499-535. doi: 10.1146/annurev.bioeng.8.010506.105023.
Since its inception in the 1960s, coronary artery bypass graft (CABG) evolved as one of the most common, best documented, and most effective of all major surgical treatments for ischemic heart disease. Despite its widespread use, however, the outcome is not always completely satisfactory. The objective of this review is to highlight the physical determinants of biomechanical design of CABG so that future procedures would have prolonged patency and better outcome. Our central axiom postulates the existence of a mechanical homeostatic state of the blood vessel, i.e., the variation in vessel wall stresses and strains are relatively small under physiological conditions. Any perturbation of mechanical homeostasis leads to growth and remodeling. In this sense, stenosis and failure of a graft may be viewed as an adaptation process gone awry. We outline the principles of engineering design and discuss the biofluid and biosolid mechanics principles that may have the greatest bearing on mechanical homeostasis and the long-term outcome of CABG.
自20世纪60年代问世以来，冠状动脉旁路移植术（CABG）已发展成为治疗缺血性心脏病最常见、记录最完备且最有效的主要外科手术之一。然而，尽管其应用广泛，但其结果并非总是完全令人满意。本综述的目的是强调CABG生物力学设计的物理决定因素，以便未来的手术能够延长血管通畅时间并取得更好的效果。我们的核心公理假定血管存在机械稳态，即在生理条件下血管壁应力和应变的变化相对较小。机械稳态的任何扰动都会导致生长和重塑。从这个意义上说，移植物的狭窄和失效可被视为一个出错的适应过程。我们概述了工程设计的原则，并讨论了可能对机械稳态和CABG长期结果影响最大的生物流体和生物固体力学原则。
