冠脉搭桥传统术式和Y-graft术式的桥血管流量对比

Hemodynamic Comparison of Coronary Artery Bypass between Conventional and LIMA Y-graft Surgical Method

目的分析传统术式和在左乳内动脉(left internal mammary artery, LIMA)上以Y型桥方式行冠状动脉旁路移植术(coronary artery bypass grafting, CABG)的术中桥血管流量情况。方法选择2019年2月至2020年3月25例行上述两种方式之一搭桥的患者,根据非LIMA移植血管近端吻合口位置,分为传统术式组(桥血管近端吻合于主动脉,n=18)和LIMA Y-graft组(桥血管近端吻合于LIMA,n=7),使用MEDISTIM VeriQ血流仪于术中行桥血管流量实时测定,比较平均血流量(mean graft flow, MGF)和搏动指数(pulsatility index, PI)。结果传统术式组和Y-graft组患者LIMA-LAD桥MGF分别为26(17)ml/min和24(31)ml/min,平均PI分别为2.02±0.90和3.68±2.19,差异均无统计学意义(P>0.05);传统术式组和Y-graft组患者非LIMA桥MGF分别为32(21.25)ml/min和27(26)ml/min,PI分别为2.57±1.17和2.89±1.70,差异也无统计学意义(P>0.05)。结论传统术式与LIMA Y-graft吻合的桥血管的血流动力学效果一致,术者可结合临床选择合适手术方案。

Objective To analyze the intraoperative graft flow pattern during coronary artery bypass grafting(CABG) between traditional method and left internal mammary artery(LIMA) Y-graft method. Methods From February 2019 to March 2020, according to the position of the proximal anastomosis of the non-LIMA, a total of 25 patients who underwent one of the above two bypass methods were selected and divided into traditional operation group(the proximal end of the graft was anastomosed to the aorta, n=18) and LIMA Y-graft group(the proximal end of the graft was anastomosed to LIMA, n=7). MEDISTIM VeriQ system was used to measure the transit time flow of the graft during the operation, and the mean graft flow(MGF) and pulsatility index(PI) were compared. Results The MGF of LIMA-LAD graft of patients in traditional operation group and Y-graft group were 26(17) ml/min and 24(31) ml/min, respectively, The average PI was 2.02±0.90 and 3.68±2.19, respectively(P>0.05). The MGF in nonLIMA graft in traditional group and Y-graft group were 32(21.25) ml/min and 27(26) ml/min, respectively, and PI were 2.57±1.17 and 2.89±1.70, respectively(P>0.05). Conclusion The hemodynamic effects of traditional operation and LIMA Y-graft anastomoses are consistent. The surgeon can select the appropriate operation scheme in combination with clinical practice.