Delahaye J P, Saint-Pierre A, Boissonnat P, Delahaye F, Durand de Gevigney G
Hôpital cardiovasculaire et pneumologique Louis-Pradel, Lyon.
Arch Mal Coeur Vaiss. 1987 Dec;80 Spec No:87-93.
The quality of revascularization is evaluated by measurements of blood flow and various imaging methods. The quality of the anastomosis and the graft flow are evaluated per-operatively by ultrasounds and by measurements of intramyocardial pH. After surgery, Doppler velocimetry and radioisotope scanning assess the basal coronary flow and the coronary reserve. Graft patency can be studied by noninvasive methods (Doppler and kinetic CT with contrast injection), but conventional or digital angiography is irreplaceable for visualization. Residual myocardial ischaemia and left ventricular function are evaluated by the usual methods. Angina is not sensitive enough to serve as an indicator of residual or recurrent myocardial ischaemia. ECG at rest detects most peri-operative infarctions; Holter recordings may reveal a silent myocardial ischaemia; exercise stress ECG evaluates (albeit with insufficient sensitivity) post-bypass changes in myocardial ischaemia. Myocardial scintigraphy with thallium-201 is more sensitive, and it locates low perfusion areas. Cardiac wall kinetics and left ventricular function at rest and during exercise are studied by echocardiography and contrast or isotopic ventriculography, pending advances in nuclear magnetic resonance imaging. Surgical results have never been compared with other methods of direct myocardial revascularization, but only with medical treatments. Outstanding among the controlled studies carried out are a European study (E.C.S.S.) and two North American studies (V.A.S. and C.A.S.S.); they have shown what can be expected from coronary bypass, globally and in some subgroups of patients.
通过血流量测量和各种成像方法来评估血运重建的质量。术中通过超声和心肌内pH值测量来评估吻合口质量和移植物血流。术后，多普勒测速法和放射性同位素扫描可评估基础冠状动脉血流和冠状动脉储备。移植物通畅情况可通过非侵入性方法（多普勒和注射造影剂的动态CT）进行研究，但传统血管造影或数字血管造影对于可视化而言是不可替代的。残余心肌缺血和左心室功能通过常规方法进行评估。心绞痛作为残余或复发性心肌缺血的指标不够敏感。静息心电图可检测出大多数围手术期梗死；动态心电图记录可能会揭示无症状性心肌缺血；运动负荷心电图评估（尽管敏感性不足）搭桥术后心肌缺血的变化。用铊-201进行心肌闪烁显像更敏感，且能定位低灌注区域。在核磁共振成像取得进展之前，通过超声心动图以及造影或同位素心室造影来研究静息和运动时的心脏壁动力学及左心室功能。手术结果从未与其他直接心肌血运重建方法进行过比较，而仅与药物治疗进行了比较。在已开展的对照研究中，一项欧洲研究（欧洲冠心病外科研究）和两项北美研究（退伍军人管理局研究和冠状动脉搭桥手术研究）尤为突出；它们已表明了在全球范围内以及某些患者亚组中冠状动脉搭桥术所能达到的效果。
