Cremer J, Liesmann T, Wimmer-Greinecker G, Abraham C, Mügge A, Haverich A
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Eur J Cardiothorac Surg. 1994;8(5):240-5; discussion 246. doi: 10.1016/1010-7940(94)90153-8.
The validity of alternative arterial conduits for myocardial revascularization in comparison to internal thoracic artery (ITA) has not been sufficiently defined. Evaluation of the functional in vivo vascular properties of the different conduits may be appropriate to give a perspective on long-term graft qualities. The intraoperative function of single free grafts to the left anterior descending artery (LAD) was compared in inferior epigastric (IEA, n = 13), internal thoracic (ITA, n = 12) and gastroepiploic artery (GEA, n = 12) conduits. Graft flows were measured at four points of time, 1) in situ free flow after distal dissection (IEA: 42.2 ml/min, ITA: 68.8 ml/min, GEA: 61.1 ml/min), 2) free flow following proximal grafting to the aorta (IEA: 48.1 ml/min, ITA: 63.7 ml/min, GEA: 84.2 ml/min), 3) selective graft flow after distal attachment to the LAD (IEA: 52.6 ml/min, ITA: 77.5 ml/min, GEA: 102.8 ml/min), and 4) selective LAD graft flow following paraverine (Pap) stimulation (IEA: 98.4 ml/min, ITA: 128.0 ml/min, GEA: 142.9 ml/min). Endothelium-dependent and -independent relaxation was evaluated by examination of the intraluminal graft pressures at mechanically controlled constant flow rates. Following stimulation with substance P (SP), the change of intraluminal pressure (dp) was similar in IEA (dp: -20.0 mmHg) and GEA grafts (dp: -21.1 mmHg). Only ITA conduits were less reactive to SP (-9.7 mmHg). The response to acetylcholine (ACh) could only be assessed in ITA (dp: -16.0 mmHg) and IEA (dp: -10.7 mmHg) grafts. Gastroepiploic arteries did not react on ACh stimulation (dp: +0.4 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)
与胸廓内动脉（ITA）相比，用于心肌血运重建的替代动脉血管的有效性尚未得到充分界定。评估不同血管移植物在体内的功能血管特性，可能有助于了解长期移植物质量。比较了游离腹壁下动脉（IEA，n = 13）、胸廓内动脉（ITA，n = 12）和胃网膜动脉（GEA，n = 12）作为单一游离移植物至左前降支动脉（LAD）的术中功能。在四个时间点测量移植物血流：1）远端游离解剖后的原位游离血流（IEA：42.2 ml/min，ITA：68.8 ml/min，GEA：61.1 ml/min）；2）近端与主动脉吻合后的游离血流（IEA：48.1 ml/min，ITA：63.7 ml/min，GEA：84.2 ml/min）；3）远端与LAD吻合后的选择性移植物血流（IEA：52.6 ml/min，ITA：77.5 ml/min，GEA：102.8 ml/min）；4）罂粟碱（Pap）刺激后的选择性LAD移植物血流（IEA：98.4 ml/min，ITA：128.0 ml/min，GEA：142.9 ml/min）。通过在机械控制的恒定流速下检查管腔内移植物压力，评估内皮依赖性和非依赖性舒张功能。用P物质（SP）刺激后，IEA（dp：-20.0 mmHg）和GEA移植物（dp：-21.1 mmHg）的管腔内压力变化相似。只有ITA血管对SP的反应较小（-9.7 mmHg）。仅在ITA（dp：-16.0 mmHg）和IEA（dp：-10.7 mmHg）移植物中评估了对乙酰胆碱（ACh）的反应。胃网膜动脉对ACh刺激无反应（dp：+0.4 mmHg）。（摘要截断于250字）
