Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the internal thoracic artery
Assessment of sternal vascularity with single photon emission computed tomography after harvesting of the internal thoracic artery
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DOI：
10.1016/s0022-5223(99)70188-1
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发表时间：
1999-09-01
影响因子：
6
通讯作者：
Schachner, A
中科院分区：
文献类型：
--
作者：
Cohen, AJ;Lockman, J;Schachner, A
目的：前瞻性评价切取左胸廓内动脉对胸骨血供的影响。方法：连续24例接受直接冠状动脉旁路移植术的患者。一名患者在手术过程中改变了手术程序，他被排除在研究之外。这些患者被前瞻性随机分配接受去离子的胸廓内动脉I组（n = 11）或带蒂胸廓内动脉（IT组，n = 12）移植物，每例患者术前均接受单光子发射计算机断层扫描（SPECT）99锝亚甲基二膦酸盐骨扫描，比较胸骨左侧每像素平均计数与右侧每像素平均计数的比值。术后所有患者均进行第二次扫描，并将胸骨摄取与术前摄取进行比较。两组之间的观察结果显示，与I组相比，IT组术后胸骨左侧的血流量在统计学上显著减少（0.61 +/- 0.11 vs 0.85 +/- 0.09; P <0.001）。术前和手术变量的多变量logistic回归分析显示，只有带蒂左胸廓内动脉与左-右胸骨活动比减少20%或更多相关（比值比，100; 70%置信限，22-465; P = 0.002）。结论：带蒂的左胸廓内动脉移植到左前降支动脉，在术后急性期减少胸骨左侧的血液，这在左胸廓内动脉栓塞时不会发生。
Objective: This study prospectively evaluates the effect on sternal vascularity of harvesting the left internal thoracic artery. Methods: Twenty-four consecutive patients undergoing primary coronary artery bypass grafting were studied. One patient's procedure tvas altered during the operation, and he was eliminated from the study, The patients were prospectively randomized to receive a skeletonized internal thoracic artery (group I, n = 11) or a pedicled internal thoracic artery (group IT, n = 12) graft, Each patient underwent a preoperative technetium 99 methylene diphosphonate bone scan using single photon emission computed tomography, The ratio of the mean counts per pixel on the left side of the sternum was compared with the mean counts per pixel on the right side. Postoperatively, all patients had a second scan, and sternal uptake was compared with the preoperative uptake, Results: No significant differences in preoperative and operative variables were? observed between the groups, A statistically significant reduction in blood flow to the left side of the sternum was shown postoperatively in group IT compared with group I (0.61 +/- 0.11 vs 0.85 +/- 0.09; P < .001). Multivariable logistic regression analysis of preoperative and operative variables revealed only a pedicled left internal thoracic artery to be associated with a 20% or more reduction in left-to-right sternal activity ratio (odds ratio, 100; 70% confidence limits, 22-465; P = .002). Conclusion: A pedicled left internal thoracic artery graft to the left anterior descending artery reduces blood now to the left side of the sternum during the acute postoperative period, This does not occur when the left internal thoracic artery is skeletonized.