Objective\ The relationship between graft blood flow, epicardial microflow, mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure. Methods\ These parameters were done to ...Objective\ The relationship between graft blood flow, epicardial microflow, mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure. Methods\ These parameters were done to evaluate the use of repeated cardiopulmonary bypass support for the intraoperative heart failure following aorto coronary bypass surgery. Included in this study were 10 patients with a mean age of 70 and unstable angina undergoing coronary bypass grafting and suffering from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressure and blood cell filterability were measured. Resluts\ During heart failure, the mean arterial pressure fell by 41%(P<0.01), graft flow by 67%(P<0.01) and epicardialmicroflow by 64%(P<0.01). After 15 to 56 min of assisted cardiopulmonary bypass support, the epicardial microflow and graft flow were partially restored, while red cell and white cell filterability was reduced by 31% and 64% respectively (P<0.01). There were significant correlations between graft flow, epicardial microflow, blood cell filterability and cardiopulmonary bypass time. All patients recovered and were discharged from the hospital.Conclusion\ It is concluded that the use of temporary assisted CPB support to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores the mean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. The CPB support seemed to be suitable for about 60 min probably because of increasing disturbance to the blood cell filterability, graft flow and the epicardial microcirculation.\;展开更多
Objective： To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods ： The grafts flow was studied in 100 patients of OPCAB and...Objective： To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods ： The grafts flow was studied in 100 patients of OPCAB and compared with 100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results： The mean number of the distal anastomosis was 3.78＋ 1.11 in CCABG group, and 3.83 ＋ 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 ＋ 0.08, and 1.10＋ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups. Conclusion： OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.展开更多
Platelet concentration near the blood vessel wall is one of the major factors in the adhesion of platelets to the wall.In our previous studies,it was found that swirling flows could suppress platelet adhesion in small...Platelet concentration near the blood vessel wall is one of the major factors in the adhesion of platelets to the wall.In our previous studies,it was found that swirling flows could suppress platelet adhesion in small-caliber artificial grafts and end-to-end anastomoses.In order to better understand the beneficial effect of the swirling flow,we numerically analyzed the near-wall concentration distribution of platelets in a straight tube and a sudden tubular expansion tube under both swirling flow and normal flow conditions.The numerical models were created based on our previous experimental studies.The simulation results revealed that when compared with the normal flow,the swirling flow could significantly reduce the near-wall concentration of platelets in both the straight tube and the expansion tube.The present numerical study therefore indicates that the reduction in platelet adhesion under swirling flow conditions in small-caliber arterial grafts,or in end-to-end anastomoses as observed in our previous experimental study,was possibly through a mechanism of platelet transport,in which the swirling flow reduced the near-wall concentration of platelets.展开更多
The application of small diameter arterial grafts is limited due to the fact of relatively poor long-time patency which is caused by thrombosis formation in the short term and intimal hyperplasia(IH) in the medium and...The application of small diameter arterial grafts is limited due to the fact of relatively poor long-time patency which is caused by thrombosis formation in the short term and intimal hyperplasia(IH) in the medium and long term.Thrombosis,obstructing the flow of blood展开更多
The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lack...The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lacking. We aimed to assess the 4-year long-term safety and effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) and FFR-guided coronary artery bypass graft surgery (CABG) for the treatment of proximal left anterior descending (LAD) lesions. The study included 129 patients with functionally significant (FFR ≤ 0.80) isolated proximal LAD stenosis (PCI, 88 patients vs. CABG, 41). Clinical endpoints were assessed by Kaplan-Meier method and compared by the log-rank test. At a mean follow-up time of 47 ± 12 months, a higher incidence of myocardial infarction in the PCI group (PCI: 32% vs. CABG: 15%;p = 0.003) and a higher incidence of stroke in the CABG group (CABG: 3 (7%) vs. PCI 0 (0%);p = 0.031) were observed. However, there were no significant differences in the primary composite endpoint, death and target vessel revascularization between PCI and CABG groups. The PCI and CABG in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoints. However, stroke was more frequent in the CABG group than in the PCI group.展开更多
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracor...Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.展开更多
Transit-time flow technology is considered as a quality of care in bypass surgery especially in off pump revascularization. Transit time flow measurement is a real time, direct, easy and handy tool for assessment qual...Transit-time flow technology is considered as a quality of care in bypass surgery especially in off pump revascularization. Transit time flow measurement is a real time, direct, easy and handy tool for assessment quality of anastomosis and graft blood flow.展开更多
目的评估瞬时流量测定(transit time flow meter,TTFM)技术在冠状动脉旁路移植术(CABG)中探查移植血管血流通畅状态的应用价值,并分析其测定结果的相关因素。方法对我科2002年3月至2004年1月连续行CABG 301例患者的791支血管移植物进行T...目的评估瞬时流量测定(transit time flow meter,TTFM)技术在冠状动脉旁路移植术(CABG)中探查移植血管血流通畅状态的应用价值,并分析其测定结果的相关因素。方法对我科2002年3月至2004年1月连续行CABG 301例患者的791支血管移植物进行TTFM测定,按照入选标准从中筛选出左乳内动脉(LIMA)旁路移植到左前降支(LAD)的165例患者的TTFM结果,进行血流量和搏动指数(pulsatility index,PI)的多因素分析。结果TTFM技术提示,791支移植物中有严重质量问题的移植血管5支,均手术证实并加以改正。可能影响移植物血流量的主要因素为LAD远端直径、LIMA直径、心肌梗死位置、LAD近端狭窄程度、反流量百分比(percentage of insufficiency)、左心室舒张期末内径、手术方式(体外循环和非体外循环);影响PI值的主要因素为LAD远端直径、反流量百分比和手术方式。结论TTFM在判断CABG移植物状态时具有一定的诊断价值。多种因素均可影响移植物的血流量和PI值,应考虑主要影响因素以及临床表现来提高TTFM诊断技术错误的敏感性。展开更多
文摘Objective\ The relationship between graft blood flow, epicardial microflow, mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure. Methods\ These parameters were done to evaluate the use of repeated cardiopulmonary bypass support for the intraoperative heart failure following aorto coronary bypass surgery. Included in this study were 10 patients with a mean age of 70 and unstable angina undergoing coronary bypass grafting and suffering from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressure and blood cell filterability were measured. Resluts\ During heart failure, the mean arterial pressure fell by 41%(P<0.01), graft flow by 67%(P<0.01) and epicardialmicroflow by 64%(P<0.01). After 15 to 56 min of assisted cardiopulmonary bypass support, the epicardial microflow and graft flow were partially restored, while red cell and white cell filterability was reduced by 31% and 64% respectively (P<0.01). There were significant correlations between graft flow, epicardial microflow, blood cell filterability and cardiopulmonary bypass time. All patients recovered and were discharged from the hospital.Conclusion\ It is concluded that the use of temporary assisted CPB support to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores the mean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. The CPB support seemed to be suitable for about 60 min probably because of increasing disturbance to the blood cell filterability, graft flow and the epicardial microcirculation.\;
文摘Objective： To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods ： The grafts flow was studied in 100 patients of OPCAB and compared with 100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results： The mean number of the distal anastomosis was 3.78＋ 1.11 in CCABG group, and 3.83 ＋ 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 ＋ 0.08, and 1.10＋ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups. Conclusion： OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.
基金supported by Grant-in-Aid from the National Natural Science Foundation of China (10632010,11072023)
文摘Platelet concentration near the blood vessel wall is one of the major factors in the adhesion of platelets to the wall.In our previous studies,it was found that swirling flows could suppress platelet adhesion in small-caliber artificial grafts and end-to-end anastomoses.In order to better understand the beneficial effect of the swirling flow,we numerically analyzed the near-wall concentration distribution of platelets in a straight tube and a sudden tubular expansion tube under both swirling flow and normal flow conditions.The numerical models were created based on our previous experimental studies.The simulation results revealed that when compared with the normal flow,the swirling flow could significantly reduce the near-wall concentration of platelets in both the straight tube and the expansion tube.The present numerical study therefore indicates that the reduction in platelet adhesion under swirling flow conditions in small-caliber arterial grafts,or in end-to-end anastomoses as observed in our previous experimental study,was possibly through a mechanism of platelet transport,in which the swirling flow reduced the near-wall concentration of platelets.
文摘The application of small diameter arterial grafts is limited due to the fact of relatively poor long-time patency which is caused by thrombosis formation in the short term and intimal hyperplasia(IH) in the medium and long term.Thrombosis,obstructing the flow of blood
文摘The data about FFR-guided revascularization in isolated proximal LAD disease are limited and studies comparing long-term outcomes of FFR-guided PCI versus FFR-guided CABG in single-vessel proximal LAD disease are lacking. We aimed to assess the 4-year long-term safety and effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) and FFR-guided coronary artery bypass graft surgery (CABG) for the treatment of proximal left anterior descending (LAD) lesions. The study included 129 patients with functionally significant (FFR ≤ 0.80) isolated proximal LAD stenosis (PCI, 88 patients vs. CABG, 41). Clinical endpoints were assessed by Kaplan-Meier method and compared by the log-rank test. At a mean follow-up time of 47 ± 12 months, a higher incidence of myocardial infarction in the PCI group (PCI: 32% vs. CABG: 15%;p = 0.003) and a higher incidence of stroke in the CABG group (CABG: 3 (7%) vs. PCI 0 (0%);p = 0.031) were observed. However, there were no significant differences in the primary composite endpoint, death and target vessel revascularization between PCI and CABG groups. The PCI and CABG in isolated proximal LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoints. However, stroke was more frequent in the CABG group than in the PCI group.
文摘Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
文摘Transit-time flow technology is considered as a quality of care in bypass surgery especially in off pump revascularization. Transit time flow measurement is a real time, direct, easy and handy tool for assessment quality of anastomosis and graft blood flow.
文摘目的评估瞬时流量测定(transit time flow meter,TTFM)技术在冠状动脉旁路移植术(CABG)中探查移植血管血流通畅状态的应用价值,并分析其测定结果的相关因素。方法对我科2002年3月至2004年1月连续行CABG 301例患者的791支血管移植物进行TTFM测定,按照入选标准从中筛选出左乳内动脉(LIMA)旁路移植到左前降支(LAD)的165例患者的TTFM结果,进行血流量和搏动指数(pulsatility index,PI)的多因素分析。结果TTFM技术提示,791支移植物中有严重质量问题的移植血管5支,均手术证实并加以改正。可能影响移植物血流量的主要因素为LAD远端直径、LIMA直径、心肌梗死位置、LAD近端狭窄程度、反流量百分比(percentage of insufficiency)、左心室舒张期末内径、手术方式(体外循环和非体外循环);影响PI值的主要因素为LAD远端直径、反流量百分比和手术方式。结论TTFM在判断CABG移植物状态时具有一定的诊断价值。多种因素均可影响移植物的血流量和PI值,应考虑主要影响因素以及临床表现来提高TTFM诊断技术错误的敏感性。
