Borowski Andreas, Godehardt Erhard, Dalyanoglu Hannan
Clinic of Cardiovascular Surgery, University of Duesseldorf, Moorenstrasse 5, 40255, Duesseldorf, Germany.
Gen Thorac Cardiovasc Surg. 2017 Jan;65(1):17-24. doi: 10.1007/s11748-016-0702-8. Epub 2016 Aug 8.
Chronic totally occluded right coronary artery (CTO-RCA) often poses a problem in decision making for/against bypass grafting due to the lack of standardized indication criteria. The aim of the study was to investigate whether qualitative angiograms can be useful in decision making for/against surgical revascularization of CTO-RCA.
A retrospective cohort study was conducted with 69 patients who underwent elective CABG procedure, including single graft to the RCA. The distal run-off of the bypassed RCA was measured intraoperatively using the ultrasonic transit-time method. As a primary endpoint of the study, the flow values were analysed in regard to diameter of the recipient artery. As a secondary endpoint, the correlations between the regional and global LV function, Rentrop grading, type of collateral pathway, number of donor sources, comorbidity, and the graft flow and the diameter of the recipient artery were investigated using uni- and multi-variate regression analyses.
In general, the flow values correlated significantly with the diameter of the recipient artery. Significantly lower flow (p < 0.0001) and diameter values (p < 0.05) were found in hypo/akinetic and infarcted area reflecting functionality of the CTO-RCA territory.
The qualitative angiograms combined with regional wall motion studies can be useful in decision making for revascularization of CTO-RCA. Revascularization of akinetic/infarcted CTO-RCA territory is associated with lower graft flows even in patients presented with high Rentrop class and high degree of collaterality, suggesting necessity of viability tests prior to bypass surgery.
由于缺乏标准化的适应症标准，慢性完全闭塞的右冠状动脉（CTO-RCA）在决定是否进行旁路移植术时常常带来问题。本研究的目的是调查定性血管造影在决定是否对CTO-RCA进行外科血运重建时是否有用。
对69例行择期冠状动脉旁路移植术（CABG）的患者进行了一项回顾性队列研究，包括对RCA进行单支移植。术中使用超声渡越时间法测量旁路RCA的远端血流。作为研究的主要终点，分析血流值与受体动脉直径的关系。作为次要终点，使用单变量和多变量回归分析研究局部和整体左心室功能、Rentrop分级、侧支循环途径类型、供体来源数量、合并症以及移植血流与受体动脉直径之间的相关性。
一般来说，血流值与受体动脉直径显著相关。在反映CTO-RCA区域功能的运动减弱/无运动和梗死区域，发现血流（p < 0.0001）和直径值（p < 0.05）显著降低。
定性血管造影结合局部壁运动研究在决定CTO-RCA血运重建时可能有用。即使在Rentrop分级高和侧支循环丰富的患者中，运动减弱/梗死的CTO-RCA区域的血运重建与较低的移植血流相关，提示在旁路手术前进行存活能力测试的必要性。
