Satdhabudha Opas, Noppawinyoowong Narupa
Department of Surgery, Faculty of Medicine, Thammasat University, 95 Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani, 12120, Thailand.
J Cardiothorac Surg. 2017 May 16;12(1):28. doi: 10.1186/s13019-017-0589-1.
Harvesting the internal thoracic artery (ITA) with semiskeletonization is an alternative technique between conventional wide pedicle and skeletonization. It is almost as simple as pedicle harvesting; however, it is supposed to provide the advantage of graft flow and length. Since the heart is unique being the only organ which is perfused during diastole, for comparing the intraoperative graft flow characteristics of semiskeletonization and pedicle technique, we used diastolic filling (DF) using transit-time flow measurement as a primary result. The objective of this study is to compare if semiskeletonized ITA has a greater effect on the intraoperative DF of graft flow versus conventional pedicled ITA in coronary artery bypass.
Between July 2015 and May 2016, a prospective evaluation of 60 consecutive patients undergoing coronary artery bypass grafting for left anterior descending artery revascularization were randomized to having semiskeletonized (n = 30) or conventional pedicled (n = 30) ITA graft harvested by the same surgeon. Intraoperative transit-time flows were obtained. The DF of the ITA graft at the end of operation was evaluated in two groups.
The intraoperative DF was significantly greater in the semiskeletonized grafts than in the pedicled grafts (70.50 ± 14.15 versus 57.6 ± 19.39%; p = 0.005). No statistical difference was observed comparing quantitative pulsatile flow and pulsatile index at the end of the operation in the two groups. However, the free flow of the conduit during the cardiopulmonary bypass before the anastomosis performed was greater in semiskeletonized group than in pedicled group (94 ± 48.37 versus 56.35 ± 34.90 ml/min; p = 0.003). The total operative time was comparable between two groups (p = 0.092).
Semiskeletonized ITA resulted in superior DF of left anterior descending bypass graft flow as compared with pedicled ITA. It is also provide a greater free flow and length of the graft without the long-delayed operative time.
Trial registration number (Study ID): TCTR20160913002 Date of registration: September 10, 2016.
采用半骨骼化技术获取胸廓内动脉（ITA）是一种介于传统宽蒂和骨骼化技术之间的替代技术。它几乎与蒂部获取技术一样简单；然而，它被认为具有移植物血流和长度方面的优势。由于心脏是唯一在舒张期进行灌注的独特器官，为了比较半骨骼化技术和蒂部技术的术中移植物血流特征，我们将使用通过渡越时间血流测量得到的舒张期充盈（DF）作为主要结果。本研究的目的是比较在冠状动脉旁路移植术中，半骨骼化的ITA与传统带蒂ITA相比，对术中移植物血流的DF是否有更大影响。
在2015年7月至2016年5月期间，对60例连续接受冠状动脉旁路移植术以实现左前降支血管重建的患者进行前瞻性评估，这些患者被随机分为两组，一组由同一位外科医生采用半骨骼化技术获取ITA移植物（n = 30），另一组采用传统带蒂技术获取ITA移植物（n = 30）。获取术中渡越时间血流数据。在两组中评估手术结束时ITA移植物的DF。
半骨骼化移植物的术中DF显著高于带蒂移植物（70.50 ± 14.15% 对57.6 ± 19.39%；p = 0.005）。两组在手术结束时比较定量搏动血流和搏动指数，未观察到统计学差异。然而，在进行吻合前的体外循环期间，半骨骼化组移植物的自由血流大于带蒂组（94 ± 48.37对56.35 ± 34.90 ml/min；p = 0.003）。两组的总手术时间相当（p = 0.092）。
与带蒂ITA相比，半骨骼化ITA导致左前降支旁路移植物血流的DF更优。它还能提供更大的移植物自由血流和长度，且不会延长手术时间。
试验注册号（研究ID）：TCTR20160913002 注册日期：2016年9月10日。
