左冠状动脉区域的动脉和静脉旁路移植术中的血流谱。

Intraoperative flow profiles of arterial and venous bypass grafts to the left coronary territory.

机构信息

University of Oxford, Oxford, UK.

Department of Cardiovascular Surgery, Oxford University Hospitals Trust, Oxford, UK.

出版信息

Eur J Cardiothorac Surg. 2019 Jul 1;56(1):64-71. doi: 10.1093/ejcts/ezy473.

DOI:10.1093/ejcts/ezy473

PMID:30715312

Abstract

OBJECTIVES

The different mechanical and vasodilatory properties of arteries and veins may influence their flow profiles when used for coronary artery bypass grafting (CABG). This may be of significance when assessing the cut-off values for adequate flow. However, conduit-related flow differences are less examined.

METHODS

In a study of 268 patients, transit time flowmetry parameters of 336 arterial and 170 venous conduits all grafted to the left coronary territory were compared. With transit time flowmetry, the mean graft flow (MGF), pulsatility index, percentage of diastolic filling and percentage of backwards flow were measured. Conduit-related differences were further compared according to on- or off-pump CABG (ONCABG versus OPCABG) surgery.

RESULTS

Overall MGF and pulsatility index were comparable between arterial and venous grafts, but in arterial grafts, MGF was higher during ONCABG than during OPCABG (49.1 ± 35.3 ml/min vs 38.8 ± 26.6 ml/min; P = 0.003). Percentage of diastolic filling was higher in arterial grafts than in venous grafts (overall 71.0 ± 7.9% vs 63.7 ± 11.1%; ONCABG 69.9 ± 7.1% vs 63.9 ± 10.4%; OPCABG 71.9 ± 8.3% vs 63.4 ± 12.2%; all P < 0.001). Furthermore, percentage of backwards flow was higher in arterial grafts than in venous grafts in the overall (2.3 ± 3.2% vs 1.7 ± 3.2%, P = 0.002) and in the ONCABG (2.3 ± 3.2% vs 1.3 ± 2.5%, P < 0.001) cohorts. In venous grafts, percentage of backwards flow was lower during ONCABG versus OPCABG (1.3 ± 2.5% vs 2.6 ± 3.9%, P = 0.016).

CONCLUSIONS

No statistically significant difference was observed for MGF and pulsatility index between arterial and venous conduits. However, arterial grafts have significantly higher diastolic filling and backwards flow than venous grafts. Furthermore, arterial grafts have a significantly higher MGF in ONCABG versus OPCABG.

摘要

目的

动脉和静脉的不同机械和血管舒张特性可能会影响它们在冠状动脉旁路移植术（CABG）中的血流模式。在评估足够血流的截止值时，这可能具有重要意义。然而，对于导管相关的血流差异研究较少。

方法

在一项对 268 例患者的研究中，比较了 336 条动脉和 170 条静脉导管的瞬时流量测量参数，这些导管均移植到左冠状动脉区域。通过瞬时流量测量，测量平均移植流量（MGF）、脉动指数、舒张期充盈百分比和反流百分比。根据体外循环冠状动脉旁路移植术（ONCABG 与非体外循环冠状动脉旁路移植术（OPCABG）手术进一步比较导管相关差异。

结果

动脉和静脉移植物的 MGF 和脉动指数总体上无差异，但在 ONCABG 中，动脉移植物的 MGF 高于 OPCABG（49.1±35.3 ml/min 比 38.8±26.6 ml/min；P=0.003）。动脉移植物的舒张期充盈百分比高于静脉移植物（总体 71.0±7.9%比 63.7±11.1%；ONCABG 69.9±7.1%比 63.9±10.4%；OPCABG 71.9±8.3%比 63.4±12.2%；均 P<0.001）。此外，在总体（2.3±3.2%比 1.7±3.2%，P=0.002）和 ONCABG （2.3±3.2%比 1.3±2.5%，P<0.001）中，动脉移植物的反流百分比均高于静脉移植物。在静脉移植物中，ONCABG 时的反流百分比低于 OPCABG（1.3±2.5%比 2.6±3.9%，P=0.016）。