Ferrari Enrico, von Segesser Ludwig, Berdajs Denis
Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland Cardiovascular Research Unit, University Hospital of Lausanne, Lausanne, Switzerland
Cardiovascular Research Unit, University Hospital of Lausanne, Lausanne, Switzerland.
Multimed Man Cardiothorac Surg. 2015 May 13;2015. doi: 10.1093/mmcts/mmv005. Print 2015.
Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.
冠状动脉搭桥术仍然是患有多支冠状动脉疾病患者的最佳选择，大隐静脉被用作多次完全血运重建的额外管道。然而，静脉移植物的长期耐用性较差，10年后几乎75%的移植物会闭塞。为了提高耐用性，在过去几年中成功开发了外部支撑结构的概念：eSVS Mesh装置（基普斯湾医疗公司）是一种用于静脉移植物的外部支撑，由纬编镍钛诺丝制成管状，长度约为24厘米，有三种直径（3.5、4.0和4.5毫米）可供选择。该装置放置在静脉外壁上并小心展开以覆盖移植物的全长。该网具有柔韧性，可完全适应心脏解剖结构，旨在防止静脉扭结和扩张，此外还能抑制由全身血压引起的内膜增生。该装置设计为最多将静脉直径减小约15 - 20%，以防止动脉血压引起的静脉径向扩张以及导致移植物失败的内膜增生。我们描述了使用大隐静脉移植物外部支撑（eSVS Mesh）制备静脉移植物的手术技术，并分享我们的初步临床结果。
