Intraoperative transit time flow measurement: Off-pump versus on-pump coronary artery bypass
Intraoperative transit time flow measurement: Off-pump versus on-pump coronary artery bypass
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DOI：
10.1016/j.athoracsur.2005.03.138
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发表时间：
2005-12-01
影响因子：
4.6
通讯作者：
Ennker, J
中科院分区：
文献类型：
--
作者：
Hassanein, W;Albert, AA;Ennker, J
背景资料。非体外循环冠状动脉旁路移植术(OPCAB)日益受到重视。在非体外循环下进行吻合术在技术上要求更高。本研究的目的是评价OPCAB与传统体外循环冠状动脉旁路移植术的吻合口质量。本研究共纳入445例采用体外循环技术进行手术的患者。对于这一组中的每个患者，根据移植物的数量、搭桥材料和靶冠状动脉从体外循环冠状动脉搭桥术人群中选择一名相似的患者。测量两组搭桥血管的平均流量和搏动指数。体外循环冠脉搭桥术的平均搏动指数为2.09±1.03(平均流量为39±22.63mL/min)，体外循环冠脉搭桥术的平均搏动指数为1.9±0.98(平均流量为44.19±23.58mL/min)，P=0.005。亚组分析显示，OPCAB在钝性边缘、斜行和右冠状动脉的移植物中平均流量显著降低，搏动指数显著升高，而在左前降支的移植物中无显著差异。使用OPCAB技术进行的吻合术的质量可能会因为较难获得而受到影响，就像在冠状动脉侧壁和后壁的情况一样。在OPCAB中，应认真考虑优化冠状动脉可及性的技术，如将吊带支撑物与杯子稳定器相结合，以及系统的培训。只要冠状动脉有良好的可达性，就像在左前降支的情况下，在OPCAB下进行的吻合术具有与传统技术同样好的质量。
Background. Off-pump coronary artery bypass grafting (OPCAB) has attracted increasing attention. Performing the anastomosis off-pump is technically more demanding. The objective of the study is to assess the quality of anastomosis in OPCAB in comparison with conventional on-pump coronary artery bypass grafting using the transit time flow measurement.Methods. Four hundred forty-five patients operated on using OPCAB technique were included in the study. For each patient in this group a similar patient from the on-pump coronary artery bypass grafting population was selected according to the number of grafts, bypass material, and target coronary arteries. The mean flow and the pulsatile index were measured in every bypass graft in both groups.Results. The average pulsatile index in OPCAB was 2.09 +/- 1.03 (mean flow, 39 +/- 22.63 mL/min), whereas with on-pump coronary artery bypass grafting it was 1.9 +/- 0.98 (mean flow, 44.19 +/- 23.58 mL/min); p = 0.005. Subgroup analysis showed significantly lower mean flows and higher pulsatile index with OPCAB in grafts to the obtuse marginal, diagonal, and right coronary artery, but not to the left anterior descending territory.Conclusions. The quality of the anastomosis performed using the OPCAB technique might be jeopardized by less accessibility as in the case of lateral and posterior wall coronary arteries. Techniques to optimize the accessibility of the coronary artery like combining sling support with cup stabilizers, together with systematic training, should be strongly considered in OPCAB. Whenever there is good accessibility of the coronary artery as in the case of the left anterior descending, the anastomosis performed under OPCAB has a quality as good as that performed using the conventional technique.