Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Intraoperative Measurement and Analysis of Coronary Artery Bypass Graft Flow

수술중 측정한 관상동맥 우회도관 혈류량의 분석

  • Park, Kye-Hyun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Chae, Hurn (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Yun, Yang-Ku (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Lee, Jae-Woong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kim, Kwhan-Mien (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Jun, Tae-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Kim, Jhin-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Shim, Young-Mog (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center) ;
  • Park, Pyo-Won (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center)
  • 박계현 (삼성의료원 흉부외과) ;
  • 채헌 (삼성의료원 흉부외과) ;
  • 윤양구 (삼성의료원 흉부외과) ;
  • 이재웅 (서울대학교병원 흉부외과) ;
  • 김관민 (삼성의료원 흉부외과) ;
  • 전태국 (삼성의료원 흉부외과) ;
  • 김진국 (삼성의료원 흉부외과) ;
  • 심영목 (삼성의료원 흉부외과) ;
  • 박표원 (삼성의료원 흉부외과)
  • Published : 1997.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GHF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas upplied by grafts with low GBP. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplyinf: myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.

본 연구는 관상동맥 우회수술중 측정한 우회도관의 혈류량을 결정하는 인자들을 분석함으로써 일반적으로 적용되고 있는 수술 전략의 의의를 검토하고자 하였다. 50명의 환자를 대상으로 관상동맥 우회수술중 transit-time ultrasound flowmeter를 이용하여 총 146개의 우회 도관의 혈류량(graft blood flow; GBF)을 측정하였다. 수혜관상동맥의 내경, 해당 심근의 면적, 우회도관의 종 류, 수술전 심근 관류 스캔 소견 등의 변수와 GBF간의 상관관계를 분석하고 수술 3개월후 시행한 심근 관류 스캔 소견과의 상관관계 여부를 분석하여 다음과 같은 결과를 얻었다. 1. 연속 문합된 목재정맥 우회도관의 GBF(평균 61.5 ml/min)가 내홉동맥(평균 42.5 ml/min)이나 단순 복재정맥 우회도관의 GBF(평균 46.9 ml/min)보다 의미있게 높았다(p<0.01). 2. GBF와 myocardial value 및 수혜동맥의 내경 간에 유의할 만한 상관관계가 있었으며 심근 스캔상 관류결손 의 유무와는 상관관계가 없었다. 3. 수혜동맥 내경이 1.5 m 미만이거나 혹은 myocardial value가 2 미만인 경우에는 CBF가 유의하게 낮았다. 4. myocardial value가 같을 경우 수혜 관상동맥의 내경과 GBF간의 상관관계가 약하였던 반면 수혜동맥의 내경이 같을지라도 myocardial value가 클수록 GBF가 증가하였다. 5. GBF 측정치가 회귀분석을 통하여 구한 기대치보다 낮았던 경우와 기대치 이상이었던 경우를 비교하면 전 자에서 수술후에 해당 심근영역에서 관류결손이 발견되는 비율이 유의하게 높았다(32.2% vs 15.1%, p< 0.05). 이상의 결과는 관상동맥우회도관의 혈류량은 해당 심근 영역과 동맥계(run-of)의 크기에 의하여 주로 결정됨을 시사하는 것으로 내경 1∼1.5 m의 작은 관상동맥일지라도 지배하는 심근의 면적이 클 경우에는 우회 도관을 조성하여 줌으로써 심근 관류를 효과적으로 개선시킬 수 있고 완전 혈류재건(complete revascularization)의 목적을 달성할 수 있음을 확인시켜주는 것이라 할 수 있다. 특히 이런 경우 연속문합술을 이용함으로써 우회도관 근위의 혈류량을 증가시켜 장기 개통율의 향상을 기대할 수 있을 것이라 판단된다.

Keywords

References

  1. Ann Thorac Surg v.58 Intraoperative assessment of coronary artery bypass grafts using a pulsed Doppler flowmeter Louagie YAG;Haxhe JP;Jamart J;Buche M;Schoevaerdts JC
  2. Ann Thorac Surg v.58 Ultrasonic assessment of internal thoracic artery graft flow in the revascularized heart Canver CC;Dame NA
  3. Ann Thorac Surg v.57 Intraoperative electromagnetic flowmeter measurements in coronay artery bypass grafts Louagie YA;Haxhe J;Buche M;Schoevaerdts J
  4. J Thorac Cardiovasc Surg v.85 Prognosis for aorta-coronary graft patency. A comparison of preoperative and intraoperative assessments Sharma GV;Khuri SF;Folland Ed;Barsamian EM;Parisi AF
  5. J Cardiovasc Surg v.27 Reliability of intraoperative flow measurements to determine early graft patency with simultaneous introduction of a new method for distal coronary artery run-off capacity Korfer R;Meurs G;Seifert D;Schmiel K;Spiller P;Bircks W
  6. J Thorac Cardiovasc Surg v.71 Operative flow measurements and coronary bypass graft patency Marco VD;Barner HB;Kaiser GC(et al)
  7. Scand J Thorac Cardiovasc Surg v.12 Aortocoronary saphenous vein bypass graft: perioperative flow studies related to late graft patency Nitter-Hauge S;Hall KV;Froysaker T
  8. Ann Thorac Surg v.47 Thermal coronary angiography: a method for assessing graft patency and coronary anatomy in coronary bypass surgery Mohr FW;Matloff J;Grundfest W(et al)
  9. J Card Surg v.10 intraoperative angioscopy for coronary bypass surgery Siegel SB;White GH;Colman PD;Nelson RJ
  10. J Surg Research v.44 Blood flow velocity of internal mammary artery and saphenous vein grafts to the coronary arteries Bandyk DF;Galbraith TA;Haasler GB;Almassi GH
  11. Am Heart J v.93 Comparative study of the postoperative flow in the saphenous vein and internal mammary artery bypass grafts Hamby RI;Aintablian A;Wisoff BG;Hartstein ML
  12. Lancet v.339 Transcutaneous ultrasound measurement of blood-flow in internal mammary artery to coronary artery grafts De Bono DP;Samani NJ;Spyt TJ;Hartshorne T;Thrush AJ;Evans DH
  13. Ann Thorac Surg v.57 Effect of chronic native flow competition on internal thoracic artery grafts Lust RM;Zeri RS;Spence PA(et al)
  14. J Thorac Cardiovasc Surg v.104 A quantitative study of postoperative luminal narrowing of the internal thoracic artery graft in coronary artery bypass surgery Seki T;Kitamura S;Kawachi K(et al)
  15. J Am Coll Cardiol v.25 Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire Akasaka T;Yoshikawa J;Yoshida K(et al)
  16. J Thorac Cardiovasc Surg v.112 Changing flow pattern of the internal thoracic artery undergoing coronary bypass grafting: continuous-wave Doppler assessment Cartier R;Dias OS;Pellerin M;Hebert Y;Leclerc Y
  17. J Thorac Cardiovasc Surg v.81 A rationale for the use of sequential coronary artery bypass grafts O'Neill MJ Jr;Wolf PD;ONeill TK;Montesano RM;Waldhausen JA
  18. Thorac Cardiovasc Surgeon v.42 Doppler flow measurement in coronary artery bypass grafts and early postoperative clinical outcome Louagie YAG;Haxhe JP;Jamart J;Buche M;Schoevaerdts JC
  19. Circ Res v.42 Velocity distribution and intimal proliferation to autologousvein graft in dogs Rittgers SE;Karayannacos PE;Guy JF(et al)
  20. J Thorac Cardiovasc Surg v.67 Hydraulic and morphologic study of fibrous intimal hyperplasia in autogenous saphenous vein bypass grafts Kennedy JH;Wieting DW;Hwang NHC(et al)