Amin Sanaz, Werner Raphael S, Madsen Per Lav, Krasopoulos George, Taggart David P
Nuffield department of surgical sciences, University of Oxford, Oxford, UK.
Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):926-931. doi: 10.1093/icvts/ivy007.
Long-term patency of saphenous vein grafts (SVGs) remains a concern after coronary artery bypass grafting. Interventions to overcome this problem include monitoring intraoperative flow profile and, more recently, external stenting of SVGs. It is not known to what extent external stenting changes the perioperative flow characteristics of SVGs. The aim of this study was to assess whether the presence of an external stent affects perioperative graft flow parameters as evaluated by transit time flowmetry.
Thirty-five patients were included from 1 centre participating in a multicentre, randomized clinical trial of external stenting of SVGs. Patients were eligible if scheduled for on-pump multivessel coronary artery bypass grafting including planned SVGs to both the right and the left coronary territories. Each patient received external stenting of a single SVG randomly allocated intraoperatively to either coronary territory. The primary end-points were mean graft flow, pulsatility index, percentage of diastolic filling and percentage of backward flow in stented versus non-stented SVGs.
External stenting was performed in 17 SVGs supplying the left territory (20 non-stented SVGs for control) and in 18 SVGs supplying the right territory (18 non-stented SVGs for control). No significant difference was found in flow parameters between stented and non-stented SVGs in the overall group or between pre-defined groups of SVGs supplying the right and left territories, respectively.
External stenting of SVGs do not affect intraoperative flow parameters significantly.
clinicaltrials.gov identifier: NCT02511834.
冠状动脉旁路移植术后，大隐静脉移植物（SVG）的长期通畅性仍是一个令人关注的问题。为克服这一问题所采取的干预措施包括术中监测血流情况，以及最近采用的SVG外部支架置入术。目前尚不清楚外部支架置入在多大程度上改变了SVG的围手术期血流特征。本研究的目的是评估外部支架的存在是否会影响通过渡越时间血流仪评估的围手术期移植物血流参数。
从参与SVG外部支架置入术多中心随机临床试验的1个中心纳入35例患者。如果患者计划进行体外循环下多支冠状动脉旁路移植术，包括计划在右冠状动脉和左冠状动脉区域均使用SVG，则符合入选标准。每位患者术中随机将单个SVG的外部支架置入术分配至任一冠状动脉区域。主要终点是支架置入与未置入SVG的平均移植物血流、搏动指数、舒张期充盈百分比和反向血流百分比。
对供应左冠状动脉区域的17条SVG进行了外部支架置入（20条未置入SVG作为对照），对供应右冠状动脉区域的18条SVG进行了外部支架置入（18条未置入SVG作为对照）。在整个组中，以及分别在供应右冠状动脉和左冠状动脉区域的预定义SVG组之间，支架置入与未置入SVG的血流参数均未发现显著差异。
SVG外部支架置入术不会显著影响术中血流参数。
clinicaltrials.gov标识符：NCT02511834。
