| ObjectiveIn this study, object is the patients those who accept off-pump internal mammary artery with radial artery "Y"-type anastomosis and absolute arterial coronary artery bypass grafting. By determining the blood flow index of internal mammary artery during its original condition, just finishing left internal mammary artery grafting and internal mammary artery-radial artery bypass grafting are completed, the condition of internal mammary artery blood flow reserving can be evaluated, providing a theoretical basis for the clinical practice of internal mammary artery-radial artery "Y"-type anastomosis absolute arterial coronary artery bypass grafting.MethodsFrom Oct 2008 to April 2010, the implementation of off-pump LIMA and radial artery "Y"-type anastomosis, absolute arterial coronary artery bypass grafting has 20 cases. Among them,12 cases were male and 8 cases were female. Aging from 52 to 76 years old, the mean age is 63 years old and weighting from 50 to78 kg, the median weight is 63kg. There were totally 88 coronary artery bypass grafting anastomoses, averaging 4.3.All patients were diagnosed as coronary artery disease (CAD) with 3 vessels stenosis by coronary angiography (CAG) before cardiac surgery. Among them, 9(45%) patients had the main left coronary artery stenosis and 70% patients were classified into angina classⅢand classⅣaccording to the Canadian Cardiovascular Association.Take the method of combing inhalation with intravenous in anesthetizing. Do a condition assessment before anesthesia to know more about the type of patients' angina, the heart function, electrocardiogram, left ventricular function, coronary angiography case, peripheral vascular case as well as liver, kidney, lung and systemic organ condition. Intraoperative control of average arterial blood pressure is 60-75mmHg and heart rate is 40～60bpm, with nitroglycerin 0.2-1ug/kg. min pumping.Taking the non-cardiopulmonary bypass LIMA and radial artery "Y"-shaped anastomosis absolute arterial coronary artery bypass grafting. Before the Surgery for LIMA, free a part of proximal short sessile smooth region at first and use the immediately blood flow tester (Medi-stim Butterfly Flowmeter,2002, Oslo, Norway) for the LIMA's measurement of blood flow in original state. After LIMA and radial artery were freeing, lined LIMA-side anastomosis of radial artery, usually lining LIMA to the middle of the left coronary artery branch,diagonal branch and left anterior descending branch of sequential grafts firstly. Measure the LIMA's main blood flow index when the circulating index was stable. Then underwent radial artery to the middle of the left coronary artery branch,blunt marginal branch of right coronary artery after left ventricular support and support sequential grafts. After the belt loop was stable, took the measurement of LIMA's blood flow index in the "Y"-shaped bridge.Statistic analysis was used with SPSS13.0 statistic software to analyze all the patients'data.Results1. A total of 20 patients with coronary artery bypass graft anastomosis was 88, each patient stoma 3 to 6, an average of 4.4. Among them, internal mammary artery anastomosis was 42,2 to 3 per patient, with an average of 2.1 and radial artery anastomosis is 46, with an average of 2.3.2. The free blood flow of LIMA in original state was 34±3.0ml/min and PI 2.3±0.4. In the radial artery sequential LIMA-General before the blood flow was 36±5.0ml/min and PI 2.1±0.2. In the radial artery sequential LIMA-General after the blood flow was 90±1.2ml/min and PI 1.0±0.5. There was statistically different between the two (P all<0.05). All LIMA's TTFM waveforms mainly showed the diastolic blood flow waveform.3. CK-MB was within normal range after 12 and 24 hours, with no severe ventricular arrhythmia, preiperative myocardial infarction, low cardiac output syndrome and other complications occurring. The angina symptoms disappeared after surgery.Conclusions1. When LIMA sequential grafts bypass line was completed, the blood flow in it was the same with that in original LIMA. After the LIMA-radial artery "Y"-shaped anastomosis and arterial coronary artery bypass grafting were finished, LIMA's main blood flow was significantly higher than that in original LIMA and when only LIMA sequential bypass graft anastomosis was completed.2. This phenomenon indicates that the original LIMA pedicle has a considerable flow reserve. The range of blood flow in certain areas has a relationship with its myocardial blood supply.3. The LIMA to radial artery "Y"-type anastomosis of coronary artery bypass graft can meet the blood flow requirement of whole heart's revascularization.4. The LIMA-radial artery "Y"-type anastomosis can take full use of artery resources to achieve complete arterial revascularization in coronary artery bypass grafting, which has a good clinical application. Its long-term effects need further research. |
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