Ohmes Lucas B, Di Franco Antonino, Di Giammarco Gabriele, Rosati Carlo Maria, Lau Christopher, Girardi Leonard N, Massetti Massimo, Gaudino Mario
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
J Thorac Dis. 2017 Apr;9(Suppl 4):S327-S332. doi: 10.21037/jtd.2017.03.77.
Early graft patency is a major determinant of morbidity and mortality following coronary artery bypass surgery. Long-term graft failure is caused by intimal hyperplasia and atherosclerosis, while early failure, especially in the first year, has been attributed, in part, to surgical error. The need for intraoperative graft evaluation is paramount to determine need for revision and ensure future functioning grafts. Transit time flowmetry (TTFM) is the most commonly used intraoperative modality, however, only about 20% of cardiac surgeons in North America use TTFM. When combined with high resolution epicardial ultrasonography, TTFM provides high diagnostic yield. Fluorescence imaging can provide excellent visualization of the coronary and graft vasculature; however, data on this subject is limited. We herein examine the literature and discuss the available techniques for graft assessment along with their limitations.
早期移植物通畅是冠状动脉搭桥手术后发病率和死亡率的主要决定因素。长期移植物失败是由内膜增生和动脉粥样硬化引起的，而早期失败，尤其是在第一年，部分归因于手术失误。术中对移植物进行评估对于确定是否需要修正以及确保移植物未来的功能至关重要。通过时间流量测定法（TTFM）是最常用的术中检测方法，然而，北美只有约20%的心脏外科医生使用TTFM。当与高分辨率的心外膜超声检查相结合时，TTFM具有较高的诊断率。荧光成像可以很好地显示冠状动脉和移植物血管系统；然而，关于这一主题的数据有限。我们在此研究文献并讨论用于移植物评估的现有技术及其局限性。
