非体外循环下双侧乳内动脉Y型桥的冠状动脉旁路移植术125例

目的总结非体外循环下采用双侧乳内动脉Y型桥进行完全心肌血运重建的冠状动脉旁路移植手术125例的近期疗效。方法2002年10月至2005年12月,完成125例不停跳非体外循环下双侧乳内动脉Y型桥的冠状动脉旁路移植手术,术中采用带蒂半骨骼化的方法分别取材左、右侧的乳内动脉,将左、右乳内动脉端侧吻合成Y型桥;在非体外循环下,应用序贯吻合的方法进行冠状动脉搭桥手术。结果全组125例患者共搭桥413支,平均搭桥支数3．3支／例。术中流量测定桥血管均通畅。全组患者无围手术期死亡。结论非体外循环下双乳内动脉Y型桥的冠状动脉旁路移植手术是安全、有效的方法,可以实现全动脉化的完全心肌血运重建,又避免手术中对升主动脉的操作,近期效果满意。     

双侧骨骼化乳内动脉在冠状动脉旁路移植术中的应用

目的总结双侧骨骼化乳内动脉在冠状动脉旁路移植术(CABG)中应用的早期临床结果。方法回顾性分析2016年10月至2017年5月我院使用双侧骨骼化乳内动脉行CABG 62例患者的临床资料,其中男54例、女8例,平均年龄(56.8±6.0)岁。观察桥血管流量、围术期临床结果及冠状动脉CT结果。结果全组患者手术均在体外循环下完成,共完成124支乳内动脉吻合,同时使用大隐静脉吻合116支,平均远端吻合口数目(4.5±0.8)个。平均体外循环时间(116.4±22.9)min,平均主动脉阻断时间(83.0±18.3)min,平均呼吸机使用时间(20.8±21.3)h,住ICU时间(2.7±1.7)d。左侧乳内动脉桥平均流量(28.8±12.4)mL/min,右侧乳内动脉桥平均流量(32.8±13.8)mL/min,大隐静脉桥平均流量(41.5±21.5)mL/min;双侧乳内动脉桥血管平均流量差异无统计学意义(P=0.112)。全组患者无围术期死亡、心肌梗死、脑血管意外发生。1例男性患者胸骨愈合不良,行清创缝合后治愈。CT血管成像显示7支静脉桥、5支动脉桥吻合口远端显影浅淡,但仍通畅;1支静脉桥未显影,提示桥血管闭塞。结论在CABG中使用双侧骨骼化乳内动脉安全可靠,具有良好的早期结果。     

使用不同移植物行选择性冠状静脉动脉化的中远期疗效观察

目的比较使用乳内动脉和大隐静脉作为桥血管行选择性冠状静脉动脉化搭桥治疗弥漫性右冠状动脉狭窄病变的中远期疗效。方法回顾性分析2003年1月至2012年12月在北京安贞医院行选择性冠状静脉动脉化搭桥75例患者的临床资料,其中术中使用大隐静脉作为桥血管进行心中静脉动脉化搭桥患者54例(大隐静脉桥组);使用乳内动脉作为桥血管进行心中静脉动脉化搭桥的患者21例(乳内动脉桥组)。于2013年11月随访患者的生存情况、近期心绞痛复发率、近期复查超声心动图和冠状动脉血管成像(CTA)等。结果乳内动脉桥组患者总生存率稍高于大隐静脉桥组(100.0%vs.83.3%),但生存曲线分析结果显示两组生存率差异无统计学意义(P=0.055)。部分患者复查CTA结果显示大隐静脉桥组患者(n=39)的桥血管和心中静脉均发生明显栓塞,而乳内动脉桥患者(n=18)的桥血管和心中静脉均有明显显影,保持通畅(P0.001)。两组患者心功能指标如左心室射血分数(LVEF)值均较术前明显增加,但两组差异无统计学意义。结论选择性冠状静脉动脉化搭桥术过程中,与大隐静脉桥相比,使用乳内动脉桥可以明显提高中远期桥血管和心中静脉的通畅率,是治疗弥漫性右冠状动脉狭窄病变的有效手段。     

非体外循环双侧乳内动脉完全心肌血运重建

目的 评估非体外循环双侧乳内动脉完全心肌血运重建治疗的效果。方法 2000年10月至2004年8月，共行双侧乳内动脉“Y”形吻合冠状动脉旁路移植（冠脉搭桥）52例，年龄33～78岁，平均56岁。3支病变者42例（80．8％），左主干病变者10例（19．2％）。心功能分级Ⅱ级46例，Ⅲ级4例。脑CT检查示陈旧性脑梗者11例（21．2％），颈动脉病变者21例（40．4％）。制备双侧乳内动脉，将游离的右侧乳内动脉吻合于左侧乳内动脉成“Y”形。均在心脏不停跳下进行冠脉搭桥，左侧乳内动脉序贯吻合对角支、左前降支，右侧乳内动脉序贯吻合于中间支、回旋支（钝缘支、左室后支）、后降支。并应用Tranortie H1311流量计进行桥血管的流量测定。结果 全组52例共行冠脉搭桥171支，平均3．3支/人。全组病人无死亡。围术期心梗2例，应用IABP 1例，开胸止血1例。全组无脑部并发症，无胸骨纵隔感染。结论 非体外循环下双侧乳内动脉“Y”形冠状动脉搭桥是安全、有效的手术方式，可以实现全动脉化的完全心肌血运重建，手术近期效果满意，远期效果有待进一步的随访观察。     

骨骼化与带蒂获取双侧乳内动脉行冠状动脉旁路移植术早期临床结果的病例对照研究

目的分析骨骼化与带蒂两种方法获取双侧乳内动脉(BIMA)对冠状动脉旁路移植术(CABG)术后早期效果的影响。方法回顾性分析2015年12月至2017年5月我科使用BIMA行CABG 152例患者的临床资料,其中男128例、女24例,平均年龄(56.5±6.8)岁。按乳内动脉获取方式分为骨骼化(s-BIMA)组和带蒂(p-BIMA)组。s-BIMA组73例,男61例、女12例,平均年龄(56.6±7.0)岁;p-BIMA组79例,男67例、女12例,平均年龄(56.3±6.7)岁。比较两组术中情况、术后并发症及引流量、出院前复查冠状动脉CTA的情况。结果无围手术期死亡。两组手术时间、体外循环时间、主动脉阻断时间、术中乳内动脉流量差异均无统计学意义(P0.05)。术后s-BIMA组胸骨切口并发症1例(1.4%),为严重胸骨切口并发症;p-BIMA组胸骨切口并发症5例(6.3%),包括严重胸骨切口并发症1例(1.3%),轻微胸骨切口并发症4例(5.1%)。s-BIMA组乳糜胸1例(1.4%),p-BIMA组乳糜胸7例(8.9%)。s-BIMA组术后当日及术后3 d引流量均低于p-BIMA组(P=0.000,0.001)。出院前复查冠状动脉CTA无乳内动脉闭塞病例。结论骨骼化获取双侧乳内动脉的安全性、可靠性与传统带蒂获取方法相同。骨骼化获取技术可以减少术后胸骨切口并发症及乳糜胸,减少术后引流量。获取双侧乳内动脉时应首选骨骼化获取技术。     

骨骼化乳内动脉在冠状动脉旁路移植术中的应用

目的总结骨骼化乳内动脉(skeletonized internal mammary artery)应用于冠状动脉旁路移植术(CABG)的早期结果和经验。方法2004年1月至2007年6月,139例患者均于静脉复合全身麻醉、在胸部正中切口体外循环下施行CABG;应用骨骼化方法采集左乳内动脉,并与前降支吻合。结果远端吻合口数3.6±1.7个/例,无胸腔积液和胸骨感染;院内死亡2例,死亡率1.4%(2/139),1例死于脑卒中,1例死于呼吸窘迫综合征;发生并发症8例,并发症发生率5.8%(8/139),其中肺部感染3例,切口皮下感染2例,低心排血量综合征3例,均通过抗感染、换药、血管活性药物治疗等措施治愈。生存患者随访2～34个月(20.6±5.9个月),随访率80.3%(110/137);所有患者无心绞痛复发,心功能恢复至～级(NYHA)。结论在CABG中应用骨骼化乳内动脉安全、可靠,早期疗效满意。     

全动脉化冠状动脉搭桥的临床应用

目的 介绍全动脉移植物行冠状动脉搭桥的早期效果和临床经验。方法 采用全动脉移植物87例冠心病患者实施冠状动脉搭桥。其中男性患者82例,女性5例;单支冠状动脉病变14例,2支病变19例,3支病变54例。62例患者术前有心肌梗死,7例合并室壁瘤,1例合并主动脉瓣关闭不全。71例患者在体外循环下行冠状动脉搭桥术,16例在非体外循环下行冠状动脉搭桥术。同时行室壁瘤切除术7例,行主动脉瓣替换1例,行冠状动脉内膜剥脱2例。应用左乳内动脉84例次,右乳内动脉46例次,胃 网膜右动脉37例次,左桡动脉51例次。单个远端吻合14例,2个19例,3个50例,4个4例。结果 围手术期死亡2例（病死率2．3％）,1例为围手术期心肌梗死低心排,1例为顽固性心律失常。3例术后发生胸骨裂开切口感染,再次清创处理后痊愈。本组患者随访1．0－30．0个月（平均13．2个月）,1例患者因突发脑血管意外在术后40d死亡,其余患者术后均恢复良好,无心绞痛症状再发。B超检查乳内动脉移植血管均通畅。结论 全动脉化冠状动脉搭桥具有良好的临床应用效果,尤其适合于年轻的冠心病患者。     

非体外循环下冠状动脉内膜剥脱后搭桥治疗弥漫性冠状动脉病变

目的探讨非体外循环心脏跳动下冠状动脉内膜剥脱后搭桥治疗弥漫性冠状动脉病变的早期临床结果和经验。方法2003年5月—2005年5月,对53例弥漫性冠状动脉病变患者行非体外循环下冠状动脉内膜剥脱后搭桥手术治疗。53例中,男性41例、女性12例,年龄55～79(64±7)岁。加拿大心脏病协会心绞痛分级：Ⅰ～Ⅱ级15例,Ⅲ级6例,Ⅳ级32例。有心肌梗死史26例(49%)。冠状动脉造影：双支病变3例,3支病变50例,其中合并左主于病变9例。左心室射血分数0．26～0．65(0．52±0．17)。53例共行70支冠状动脉内膜剥脱：左前降支系统38支,其中5例内膜剥脱后先用大隐静脉片行前降支成形,再在补片上用乳内动脉搭桥;回旋支的钝缘支8支;右冠状动脉系统24支。应用左乳内动脉53支,桡动脉2支,余均为大隐静脉桥,人均搭桥(3．8±1．1)支,再血管化指数1．03±0．07。结果术中桥血流测定显示63支桥血流满意,7支欠满意。术后2例发生围手术期心肌梗死,但对血流动力学无明显影响。53例皆痊愈出院。44例随访6～29个月,无心绞痛发作;9例失访。6例在手术后3～27个月复查冠状动脉造影,显示桥血管均通畅。结论非体外循环下冠状动脉内膜剥脱后搭桥,安全可行,再血管化程度高,是治疗弥漫性冠状动脉病变的有效方法。     

全动脉化冠状动脉旁路移植术与常规冠状动脉旁路移植术近期结果比较

目的比较使用桡动脉和乳内动脉全动脉化冠状动脉旁路移植术(CABG)与使用一根乳内动脉和静脉做常规CABG的近期手术结果。方法从1999年1月到2005年1月,阜外心血管病医院共有123例患者(男114例、女9例,年龄52.2±10.1岁)采用全动脉化CABG(全动脉化组),血管移植材料为乳内动脉和桡动脉,目标血管桥在2根以上;同期行常规CABG115例(男102例、女13例,年龄60.3±9.1岁),血管的移植材料为一根乳内动脉和若干静脉桥(常规手术组)。比较两组患者术前、术中和术后的临床结果。结果术前资料比较,全动脉化组的患者年龄更小,常规手术组3支病变患者较多(54.5%vs.86.1%,P=0.001),全动脉化组有更多患者选择非体外循环CABG(26.0%vs.57.4%,P=0.001);在体外循环CABG中,全动脉化组需要更长的手术时间;平均移植血管根数全动脉化组少于常规手术组(2.6±0.7根vs.3.4±0.9根,P=0.001);住院死亡率全动脉化组为0.8%,常规手术组为0.9%,两组比较差异无统计学意义(P=1.000);术后近期并发症发生情况两组结果相似。结论对选择适合的患者采用全动脉化CABG能够提供较为安全的近期手术结果。     

双侧乳内动脉π型桥全动脉化冠状动脉旁路移植术

目的　研究 π型桥全动脉化心肌血运重建的临床应用。　方法　 1994年 9月到 2 0 0 2年 8月对 2 2例患者根据冠状动脉病变解剖特点选用π型桥进行全动脉化心肌血运重建 ,即 3支血管病变合并对角支 /中间支中段病变时 ,采用由左侧乳内动脉小 Y型桥与前降支和对角支 /中间支吻合 ,与双侧乳内动脉 T型桥共同构成 π型桥。　结果本组无围术期死亡 ,无心肌梗死、脑血管意外和胸骨感染发生 ;1例患者术后二次开胸止血。随访 6 0 .7± 2 3.0个月 ,无心绞痛复发需要冠脉介入治疗或手术治疗者 ,也无冠心病导致的死亡发生。　结论　对 3支血管病变合并对角支 /中间支中段冠脉病变的患者 ,双侧乳内动脉 π型桥可以顺利完成全动脉化心肌血运重建 ,中期效果良好。     

70岁以上冠状动脉旁路移植术病人乳内动脉流量测量分析

目的 分析70岁以上冠状动脉旁路移植术病人乳内动脉旁路血管血流量的特点.方法 对2003年1月至2007年1月间78例70岁以上(含70岁)应用乳内动脉非体外循环冠状动脉旁路移植手术(OPCAB)的病人,使用瞬时超声血流测量技术对其乳内动脉平均血流量、搏动指数等指标进行测量并分析.结果 78例病人83根乳内动脉旁路血管平均流量(36.0±21.5)ml/min,平均搏动指数3.50±1.76,血流波形均以舒张期为主.男女性别比、平均流量和搏动指数差异无统计学意义[(39.0±23.1) ml/min对(28.0±14.7) ml/min;(3.30±1.50)对(4.10±2.22),P>0.05],但女病人平均流量较男病人偏低,搏动指数较男病人偏高.结论 70岁以上病人冠状动脉旁路移植术应用乳内动脉是安全、有效的;对老年病人乳内动脉流量的评价分析应当结合老年病人的病变特点.     

Skeletonized radial artery grafting: improved angiographic results

Background. The radial artery has been used for coronary artery bypass grafting (CABG) but its early angiographic results were relatively inferior to that of the internal mammary artery, most likely due to spasm of the graft. To avoid vasospasm we harvested the radial artery using a skeletonized technique and spasm was completely reversed before use. The graft patency of the skeletonized radial artery was compared with the radial artery graft harvested as a pedicle.

Methods. A total of 112 patients underwent isolated CABG using a pedicled radial artery between September 1, 1999, and August 31, 2000 (group P), and a total of 131 patients with a skeletonized radial artery between September 1, 2000, and August 31, 2001 (group S). An ultrasonic scalpel (Harmonic Scalpel; Ethicon Endo-Surgery, Cincinnati, OH) was used for skeletonization and removing satellite veins and surrounding tissue. CABG was performed by the standard technique. Perioperative results were prospectively collected and compared between the two groups. Early angiographic results performed within 3 months were also compared.

Results. There were two hospital deaths in group S. Major complications were observed in 11 (8.4%) in group S and 3 (2.7%) in group P (p = not significant [NS]). None were related to the radial artery graft. Angiography was obtained in 96 patients of group S and 76 patients in group P and revealed that the stenosis free graft patency rate of group S (138 of 143, 96.5%) was superior to that of group P (73 of 86, 84.9%) with p < 0.005.

Conclusions. Skeletonization of the radial artery with the ultrasonic scalpel is safe and contributes to reducing the incidence of early graft stenosis.     

机器人微创非体外循环冠状动脉旁路移植术

目的 评价da Vincis机器人系统进行胸廓内动脉(IMA)游离、小切口非体外循环下冠状动脉旁路移植术的安全性和手术效果.方法 2007年1月到2011年3月,105例患者接受机器人IMA游离、小切口非体外循环下冠状动脉旁路移植术.其中男性77例,女性28例,年龄33～77岁,平均(59±10)岁.患者术前行64排CT检查评估IMA质量,2例患者左LIMA纤细或走行异常弃用.术者于操作台前、三维成像系统下遥控机器人游离IMA并完成动脉桥与靶血管的徒手吻合.其中4例患者旁路移植后接受了杂交技术于回旋支或右冠状动脉行支架植入术.术中均以超声血流检测仪测量桥血管的波形及血流.术后以冠状动脉造影或64排CT评估桥血管的通畅性,并进行随访.结果 所有患者成功接受上述手术,无手术死亡病例.术中平均IMA血管桥血流量为(21±13) ml/min.1例于术后第1天突发心跳骤停经抢救后痊愈,复查桥血管通畅.1例合并脑梗死患者术后肺部感染,痊愈后出院.其余患者无并发症发生.术中及术后出血少,术后恢复快.随访1～51个月,平均(30±12)个月.术后冠状动脉造影或64排CT复查未见桥血管狭窄或闭塞,心绞痛症状缓解.结论 机器人IMA游离、小切口非体外循环冠状动脉旁路移植术创伤小、疗效确切、安全性好,是微创冠状动脉再血管化的重要方向之一.     

Endothelial integrity of ultrasonically skeletonized internal thoracic artery: morphological analysis with scanning electron microscopy.

OBJECTIVE: The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting (CABG). An ultrasonic scalpel makes ITA skeletonization easy and speedy, however, the ultrasonic energy that is transmitted to the artery itself can occasionally injure the endothelium. Therefore, the endothelial integrity of the ultrasonically skeletonized ITA is a major concern related to this technique. The purpose of this study is to assess the endothelial integrity of the ultrasonically skeletonized ITA. METHODS: We skeletonized the left ITA with an ultrasonic scalpel in nine patients who underwent CABG, and thereafter the terminal portion of this artery was subjected to a morphological study. The endothelial integrity of this artery was morphologically assessed using scanning electron microscopy, and the results were compared to that of the left ITA skeletonized with fine scissors. RESULTS: All ITA specimens showed a completely confluent endothelium, and no endothelial injury was observed by the scanning electron microscopic study. CONCLUSIONS: The skeletonization of the ITA with an ultrasonic scalpel had no deleterious effect on the endothelium. This morphological study confirmed the safety and the reliability of this technique, and we therefore recommend its clinical use in the skeletonization of the ITA for CABG.     

The effects of different techniques of internal mammary artery harvesting on sternal blood flow.

We investigated chest wall blood flow in a canine model to determine if the technique used to harvest the mammary artery has a differential effect on residual chest wall blood flow. Eight dogs underwent bilateral internal mammary artery mobilization; one artery was harvested as a pedicle and the other was harvested as a skeletonized vessel. Residual blood flow to the chest wall distribution of each artery was measured with radioactive microspheres. Chest wall blood flow was significantly decreased from preharvest levels after internal mammary artery mobilization regardless of the technique used. Tissue blood flows decreased to 46.9%, 22.1%, and 41.2% of baseline values for the manubrium (p < 0.01), sternum (p < 0.001), and ribs (p < 0.05), respectively. Residual sternal blood flow on the side of the skeletonized vessel was significantly greater than on the side of the pedicle graft (2.60 +/- 0.68 versus 1.27 +/- 0.27 cm3/min/100 gm, p < 0.001). We conclude that minimization of tissue mobilization during internal mammary artery harvesting may reduce sternal devascularization. This finding may have clinical significance with respect to lowering the incidence of sternal wound complications in coronary bypass surgery using the internal mammary artery as a bypass conduit.     

胸腔镜辅助冠状动脉旁路移植术的应用

【摘要】〓目的〓研究全胸腔镜下冠状动脉旁路移植术临床应用体会。方法〓2005年9月至2013年7月,冠心病患者共9例,男性5例,女性4例。均在电视胸腔镜下游离乳内动脉,行胸腔镜下冠状动脉旁路移植术。其中8例行非体外循环下左乳内动脉与前降支吻合,1例在体外循环下行房间隔缺损修补术,同期行右乳内动脉与右冠状动脉吻合。结果〓9例患者均手术成功。乳内动脉游离时间为31~47 min(39.3±5.9 min)。乳内动脉与冠状动脉的吻合时间为6~7 min(5.2±1.4 min)。术后ICU停留时间为2~4 d。术后9~12 d顺利出院。结论〓全胸腔镜下游离乳内动脉行冠状动脉旁路移植术近期效果良好。     

Robotically enhanced coronary artery bypass surgery

Robotically enhanced telemanipulation surgery is a rapidly developing technique which enables totally endoscopic cardiac surgery with utmost precision and perfection on both beating heart and arrested heart. Between December 2002 and September 2006, 268 patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system. Fourteen patients underwent total endoscopic coronary artery bypass surgery. Of these 12 were performed on a beating heart and 2 on an arrested heart. Two-hundred and fifty-four patients had endoscopic takedown of the internal mammary artery followed by minimally invasive direct coronary artery bypass in 193 patients and left anterolateral thoracotomy in 61 patients. The internal mammary artery mobilization time was 36 min (28–76 min) and the left internal mammary artery to left anterior descending artery anastomosis time ranged from 20 to 36 min for the totally endoscopic coronary artery bypass patients. The right internal mammary artery of one patient was anastomosed to diagonal artery totally endoscopically. The mean internal mammary artery flow by Doppler measurement in patients undergoing minimally invasive direct coronary artery bypass was 58 ml min⁻¹. Seven patients required conversion to median sternotomy and coronary bypass surgery on the beating heart. The mean intensive care unit stay was 1.2 days and the mean hospital stay 4.5 days. There was one in-hospital mortality. All 14 patients who underwent total endoscopic bypass surgery had coronary angiography 3 months later which showed 100% patency in 13 patients. One patient had 50% anastomotic narrowing for which coronary angioplasty was performed in the same sitting. By using telematic technology, a complete endoscopic anastomosis is possible in both single vessels and suitable double vessel disease patients. The use of robotics is now extended to achieve complete myocardial revascularization by harvesting both the internal mammary arteries and making a small thoracotomy for direct anastomosis also.     

Comparison of harmonic scalpel and high-frequency electrocautery in radial artery harvesting

AIM: We evaluated the effects of the radial artery on the functional outcomes and endothelium when the harvest was made either by harmonic scalpel or by high-frequency electrocautery. METHODS: Between 2002 and 2007, 982 patients with coronary artery diseases were operated for coronary artery revascularization. The radial arteries were harvested for 101 of these patients and divided into two groups depending on the use of the harmonic scalpel (Group A; N=51) and the high-frequency electrocautery (Group B; N=50). Harvesting time, use of hemostatic clips, frequency of spasm, in situ free flow, and endothelial damage were compared between the two groups. RESULTS: Conventional high-frequency electrocautery technique used 8.7+/-3.9 hemostatic clips versus 1.5+/-1 clips (P<0.001). In situ free blood flow was 85+/-5.5 mL/min for Group B versus 114+/-21.7 mL/min for Group A (P<0.006). The endothelial damage of the radial arteries taken down with the harmonic scalpel was significantly less than when taken down with the high-frequency electrocautery (P<0.05). There was no statistically significant difference in terms of harvesting time and spasm between the two groups (P>0.05). CONCLUSION: Ultrasonic dissection with harmonic scalpel of the radial artery is associated with a decreased use of hemostatic clips. Moreover, the harmonic scalpel has a positive effect on endothelial preservation and it was associated with increased free blood flow of the radial artery.     

Coronary artery bypass using bovine internal mammary artery

Among 760 patients who underwent coronary artery bypass graft (CABG) 8 received one or two bovine internal mammary artery grafts. The surgical procedures were 4, 3 and 3 CABG respectively in 1, 3 and 4 cases with greater saphenous veins in 4 cases, internal mammary artery in 4 cases and bovine internal mammary artery in 11 cases. The 3 mm bioflow grafts were used to revascularize the left coronary artery in 6 cases (to the left anterior descending, circumflex artery) and the right coronary artery in 5 cases. The indications for the use of bovine mammary artery grafts were lack of suitable autologous vessels because of bilateral saphenous vein stripping in 4 cases, bilateral varicose veins in 3 cases and inadequate length of vein in 1 case. Post-operative angiographic studies of these bovine mammary grafts with a maximum follow-up of 11 months showed 5 occluded grafts, 2 grafts with proximal stenosis, one graft which remained patent until the patient died and 3 grafts still under evaluation. Bovine internal mammary artery grafts provide a solution for the acute stage of coronary disease, but do not achieve total and durable revascularization. Their use must remain exceptional.     

Effects of ultrasonic skeletonization on internal thoracic and gastroepiploic arteries for coronary artery bypass grafting.

OBJECTIVE: There are few data available on the effect of ultrasonic skeletonization with the harmonic scalpel on internal thoracic artery (ITA) and gastroepiploic artery (GEA) vessel function. METHODS: Rings of segments of the skeletonized ITA, pedicled ITA, skeletonized GEA, and pedicled GEA were studied. Arterial segments were treated with high KCl and norepinephrine (NE) to obtain smooth muscle contractions. Endothelium-dependent and independent vasorelaxant potencies in 10(-6)mol/l NE-pre-constricted arteries were assessed by acetylcholine (ACh), and isosorbide dinitrate (ISDN) and diltiazem, respectively. RESULTS: There were no differences in contractile potencies induced by high KCl and NE between the rings cut from skeletonized and pedicled grafts. The rings from skeletonized and pedicled vessels also showed equal sensitivity to ISDN and diltiazem. However, the rings from pedicled grafts showed greater relaxation responses to ACh than rings from skeletonized grafts. CONCLUSION: Ultrasonic complete skeletonization with the harmonic scalpel may retain smooth muscle function of skeletonized grafts, whereas endothelial function of ultrasonic skeletonized grafts may be significantly compromised.