IN-VIVO COMPARISON OF FREE CORONARY GRAFTS USING THE INFERIOR EPIGASTRIC (IEA), THE GASTROEPIPLOIC (GEA) AND THE INTERNAL THORACIC ARTERY (ITA)

被引：8

作者：

CREMER, J

LIESMANN, T

WIMMERGREINECKER, G

ABRAHAM, C

MUGGE, A

HAVERICH, A

机构：

[1] Division of Thoracic and Cardiovascular Surgery, Surgical Center, Hannover Medical School, Hannover, Mortimer Street

[2] Division of Cardiology, Hannover Medical School, Hannover

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1994年 / 8卷 / 05期

关键词：

ARTERIAL GRAFTING; FREE GRAFTS; VASCULAR REACTIVITY; CORONARY SURGERY;

D O I：

10.1016/1010-7940(94)90153-8

中图分类号：

R5 [内科学];

学科分类号：

1002 [临床医学]; 100201 [内科学];

摘要：

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 by 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). Papaverine application resulted in the highest dp changes in all groups (IEA: -31.1 mmHg, ITA: -23.9 mmHg, GEA: -29.3 mmHg). Except for one perioperative anterior myocardial infarction following GEA-LAD grafting in one patient, no further cardiac events occurred. Control angiography revealed patency rates of 100% (ITA), 84.6% (IEA) and 80.0% (GEA). It is concluded, that IEA, GEA and ITA free grafts appear to provide sufficient blood flow, even when used in the LAD position. Free GEA grafts revealed the highest flow rates at rest and following stimulation by Pap. Vascular reactivity remained preserved in all conduits, but the sensitivity to various vasodilators is distinct in the different types of grafts.

引用

页码：240 / 246

页数：7

共 21 条

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