术中跨时间血流测量参数对不同靶区早期移植物失败的预测价值。
The predictive value of intraoperative transit-time flow measurement parameters for early graft failure in different target territories.
机构信息
Cardiac Surgery Department, Peking University People's Hospital, Beijing, China.
Cardiac Surgery Department, Peking University People's Hospital, Beijing, China.
出版信息
J Cardiol. 2021 Feb;77(2):201-205. doi: 10.1016/j.jjcc.2020.09.003. Epub 2020 Oct 2.
BACKGROUND
Early graft failure can affect the short- and long-term outcomes of patients undergoing coronary bypass grafting surgery (CABG). The aim of our study was to explore the predictive value of transit-time flow measurement (TTFM) parameters for early graft failure (before discharge) after CABG in different coronary territories and calculate the TTFM cut-off values.
METHODS
We analyzed a total of 761 grafts (360 patients) that were evaluated by intraoperative TTFM and computed tomography angiography prior to discharge. Logistic model was established to detect the parameters of TTFM to predict early graft failure and receiver operating characteristic curve analysis was used to calculate the cut-off values.
RESULTS
The overall early graft failure was 3.5%. The results demonstrated that compared with off-pump CABG, mean graft flow volume was higher (28.0 vs 21.0 mL/min, p = 0.000), but pulse index (PI) (2.3 vs 2.5, p = 0.049) and diastolic flow fraction (DF) (68.0% vs 71.0%, p = 0.001) were lower in on-pump CABGs. DF (73.0% vs 65.5%, p = 0.000) of arterial grafts was higher than that of venous grafts. DF (72.0% vs 62.0%, p = 0.000) in left was higher than that in the right coronary artery territories. The results of multivariate logistic analysis showed that not only in the overall (OR 1.18, 95% CI 1.07-1.30, p = 0.001), but also the left (OR 1.21, 95% CI 1.03-1.41, p = 0.017) and right (OR 1.15, 95% CI 1.03-1.29, p = 0.017) coronary artery target territories, PI was a risk factor for early graft failure and the cut-off value was 3.4, 3.4, and 3.6, respectively. For grafts in left target territories, the results showed that DF (OR 0.94, 95% CI 0.91-0.97, p = 0.000) just in the univariate analysis was a risk factor that affected graft failure.
CONCLUSIONS
The overall early graft failure was about 3.5%. High PI value is a risk factor for early graft failure in not only overall grafts but in grafts of different target territories. DF might be more useful for the quality evaluation of grafts in left than in right target territories.
背景
早期移植物失败会影响接受冠状动脉旁路移植术（CABG）患者的短期和长期结果。本研究旨在探讨经时流量测量（TTFM）参数在不同冠状动脉靶区对 CABG 术后早期（出院前）移植物失败的预测价值，并计算 TTFM 截断值。
方法
我们分析了 761 个（360 例患者）在出院前通过术中 TTFM 和计算机断层血管造影术评估的移植物。建立逻辑模型以检测 TTFM 参数，以预测早期移植物失败，并使用受试者工作特征曲线分析计算截断值。
结果
总体早期移植物失败率为 3.5%。结果表明，与非体外循环 CABG 相比，平均移植物流量更高（28.0 与 21.0ml/min，p=0.000），但脉冲指数（PI）（2.3 与 2.5，p=0.049）和舒张期血流分数（DF）（68.0%与 71.0%，p=0.001）较低。动脉移植物的 DF（73.0%与 65.5%，p=0.000）高于静脉移植物。左冠状动脉靶区的 DF（72.0%与 62.0%，p=0.000）高于右冠状动脉靶区。多变量逻辑分析的结果表明，PI 不仅在整体（OR 1.18，95%CI 1.07-1.30，p=0.001），而且在左（OR 1.21，95%CI 1.03-1.41，p=0.017）和右（OR 1.15，95%CI 1.03-1.29，p=0.017）冠状动脉靶区也是早期移植物失败的危险因素，其截断值分别为 3.4、3.4 和 3.6。对于左冠状动脉靶区的移植物，结果表明，仅在单因素分析中，DF（OR 0.94，95%CI 0.91-0.97，p=0.000）是影响移植物失败的危险因素。
结论
总体早期移植物失败率约为 3.5%。高 PI 值不仅是整体移植物，而且是不同靶区移植物早期失败的危险因素。DF 可能更有助于评价左冠状动脉靶区移植物的质量，而不是右冠状动脉靶区。
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