Shrestha Malakh, Khaladj Nawid, Bara Christoph, Weidemann Jürgen, Maringka Michael, Zhang Ruoyu, Haverich Axel, Hagl Christian
Dept. of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Clin Res Cardiol. 2008 Jun;97(6):371-5. doi: 10.1007/s00392-007-0637-2. Epub 2008 Jan 14.
Coronary angiography is regarded as the gold standard in evaluating graft patency, Multi-slice CT (MSCT) which enable rapid imaging of cardiac structures, including coronary arteries may be a less invasive technique. Therefore in our institution a prospective pilot study was performed combining these procedures.
Starting from July 2004 a study was done with 13 patients. They received TAR using composite left internal thoracic artery (LITA) and left radial artery (RA) as T-graft. Intra-operative angiography was performed in these patients to confirm graft patency. Follow-up control (9-21 months) was performed with exercise Ergometry and 64 slides MSCT.
Mean procedure time for intra-operative angiography was 13.7 +/- 7.3 min and mean fluoroscopy time was 6.2 +/- 4.6 min. In one patient, RA-marginal artery side to side anastomoses was stenosed and had to be revised. And in another, there was a kinking of the LITA and was corrected. At follow-up, exercise ergometry showed no signs of angina or ECG-changes in all patients. MSCT showed occluded radial artery grafts in two patients. In two other patients interpretation was difficult due to resolution reasons. In all patients the LITA graft was patent.
The intra-operative graft angiography can be performed in patients undergoing TAR easily. MSCT can be used for post-operative less-invasive angiography with limitations in patients with small graft/coronary diameters and arrhythmias. However, this study shows that an interdisciplinary cooperation is a new possibility toward quality control during and after TAR.
冠状动脉造影被视为评估移植血管通畅性的金标准，能够对包括冠状动脉在内的心脏结构进行快速成像的多层螺旋CT（MSCT）可能是一种侵入性较小的技术。因此，在我们机构进行了一项将这两种检查方法相结合的前瞻性试点研究。
从2004年7月开始，对13例患者进行了研究。他们接受了使用左胸廓内动脉（LITA）和桡动脉（RA）作为T型移植物的TAR手术。术中对这些患者进行血管造影以确认移植物的通畅性。术后随访（9 - 21个月）采用运动负荷试验和64层螺旋CT进行。
术中血管造影的平均操作时间为13.7 ± 7.3分钟，平均透视时间为6.2 ± 4.6分钟。1例患者桡动脉 - 边缘动脉侧侧吻合口狭窄，需进行修正。另1例患者LITA出现扭结，已得到纠正。随访时，运动负荷试验显示所有患者均无心绞痛迹象或心电图改变。MSCT显示2例患者的桡动脉移植物闭塞。另外2例患者由于分辨率原因难以进行解读。所有患者的LITA移植物均通畅。
TAR手术患者可轻松进行术中移植物血管造影。MSCT可用于术后侵入性较小的血管造影，但对于移植物/冠状动脉直径较小及有心律失常的患者存在局限性。然而，本研究表明跨学科合作是TAR手术期间及术后质量控制的一种新途径。
