O'Neill M J, Wolf P D, O'Neill T K, Montesano R M, Waldhausen J A
J Thorac Cardiovasc Surg. 1981 May;81(5):686-90.
The use of sequential coronary artery bypass grafts has been advocated because of improved graft runoff and increased blood flow through the graft with this technique. To examine the influence of runoff, quantitated in terms of coronary vascular resistance, on the velocity of blood flow through coronary artery bypass grafts, we made two sets of simultaneous pressure and flow measurements in 106 single grafts and in 35 double sequential grafts. The first set of measurements was obtained following the aortic anastomosis and the second set of measurements was made following completion of the coronary anastomosis. Resistance of the coronary bed was calculated from the two sets of measurements. The velocity of blood flow through the grafts was calculated from vein graft diameter and the second flow measurement. No significant difference was found between the diameter of single vein grafts (4.0 +/- 0.05 mm.) and sequential vein grafts (4.1 +/- 0.09 nm.). Coronary vascular resistance in the sequential grafts (100.0 +/- 15.6 RU) was lower than that in single grafts (174.6 +/- 14.6 RU, p = 0.001). Velocity of blood flow through the proximal segment of the sequential grafts (11.1 +/- 1.1 cm/sec) was higher than that through single grafts (7.5 +/- 0.6 cm/sec, p = 0.003). The proximal segment of the sequential bypass graft has a higher velocity of blood flow than that seen in a single bypass graft. To obtain maximum hemodynamic advantage with the possibility of improving long-term patency rates, it is advisable to use the smaller coronary artery for the proximal sequential anastomosis.
由于采用这种技术可改善移植血管的血流灌注并增加通过移植血管的血流量，因此有人主张使用序贯冠状动脉搭桥术。为了研究以冠状动脉血管阻力衡量的血流灌注对冠状动脉搭桥术血管内血流速度的影响，我们对106根单支移植血管和35根双序贯移植血管进行了两组同步压力和流量测量。第一组测量是在主动脉吻合术后进行的，第二组测量是在冠状动脉吻合术完成后进行的。根据这两组测量结果计算冠状动脉床的阻力。通过移植血管的血流速度是根据静脉移植血管直径和第二次流量测量结果计算得出的。单支静脉移植血管（4.0±0.05毫米）和序贯静脉移植血管（4.1±0.09纳米）的直径之间未发现显著差异。序贯移植血管的冠状动脉血管阻力（100.0±15.6阻力单位）低于单支移植血管（174.6±14.6阻力单位，p = 0.001）。通过序贯移植血管近端的血流速度（11.1±1.1厘米/秒）高于通过单支移植血管的血流速度（7.5±0.6厘米/秒，p = 0.003）。序贯搭桥移植血管的近端血流速度高于单支搭桥移植血管。为了获得最大的血流动力学优势并有可能提高长期通畅率，建议将较小的冠状动脉用于近端序贯吻合。
