Intraoperative internal mammary artery transit-time flow measurements: comparative evaluation of two surgical pedicle preparation techniques

Détails

ID Serval
serval:BIB_F06F66C332A1
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Intraoperative internal mammary artery transit-time flow measurements: comparative evaluation of two surgical pedicle preparation techniques
Périodique
European Journal of Cardio-Thoracic Surgery
Auteur(s)
Walpoth  B. H., Mohadjer  A., Gersbach  P., Rogulenko  R., Walpoth  B. N., Althaus  U.
ISSN
1010-7940 (Print)
Statut éditorial
Publié
Date de publication
1996
Volume
10
Numéro
12
Pages
1064-8; discussion 1069-70
Notes
Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Résumé
OBJECTS: Myocardial revascularization is performed preferentially with internal mammary artery grafts. Pedicle preparation and pharmacologic vasodilatory treatment vary greatly. Objective measurements are difficult since peripheral and later coronary vascular resistance and possible competitive flow of the native bypassed coronary artery will influence the results significantly. Our objectives were: (1) measurement of internal mammary artery graft flow with the transit-time flow technique; (2) comparison of two surgical take-down techniques (skeletonizing vs standard pedicle preparation); (3) quantitation of transit-time flow compared to the free pedicle flow and (4) the vasodilatory effect of papaverine on internal mammary artery flow. METHOD: Consecutive elective cases of coronary artery bypass grafting, performed by two surgeons using routinely either skeletonizing of the internal mammary artery (group A, n = 10) or classical pedicle preparation technique (group B, n = 10), were studied prospectively. Anesthesia, cardiopulmonary bypass and operative data were otherwise comparable; likewise, hemodynamic parameters showed no statistical differences between the two groups. Transit-time flow (CardioMed, Medi-Stim, Norway) was measured at the following time points: beginning (1) and end of take-down (2); after papaverine soaking: before (3) and on cardiopulmonary bypass (4); free flow into a beaker (5); after anastomosis; on (6) and off cardiopulmonary bypass (7). RESULTS: Measurement of mean flow showed the following results: (1) severe vasoconstruction of the internal mammary artery was detected in both groups regardless of the preparation technique (occurring earlier in group A); (2) papaverine soaking caused a moderate flow increase (up to 40%); (3) with corresponding cardiopulmonary bypass flow (4.4 vs. 4.1 l/min in group B) a higher free flow in group A was evident (67.7 vs. 50.7 ml/min); (4) after coronary grafting, transit-time flow showed no significant differences between the two groups and (5) using a 3 mm probe, a linear correlation was demonstrated between transit-time flow and simultaneously measured free flow (r = 0.89). CONCLUSION: Intraoperative transit-time flow measurement is a reliable method for assessing internal mammary artery and coronary artery bypass flow; considering the simple technical application, the procedure may be regarded as a valuable instrument of quality control.
Mots-clé
Blood Flow Velocity *Coronary Artery Bypass Coronary Circulation/*physiology Electrophysiology/*methods Female Humans Male Mammary Arteries/drug effects/*physiology/transplantation Monitoring, Intraoperative/*methods Papaverine/diagnostic use Prospective Studies Reproducibility of Results Vasodilation/drug effects Vasodilator Agents/diagnostic use
Pubmed
Création de la notice
28/01/2008 10:17
Dernière modification de la notice
03/03/2018 22:36
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