冠脉搭桥术中流量监测.pptVIP

Graft Patency Verification Why measure flow ? Pulse is not the same as flow D’Ancona, G, et al. Eur J Cardio-thor Surg, 17 (2000), 287-293 ECG changes do not occur in all patients with occluded grafts Jakobsen HL, Kjaergard HK Scand J Cardiovasc Surg, No. 32; 1-3 Reperfusion of the myocardium is subjective Flow CurveSynchronized with ECG, for easy detection of the Diastolic Filling Pattern Central Parameters Mean flow value, Q (ml/min)Pulsatility Index (PI):  Reading the flow-curve How to Understand a Flow Curve?LIMA-LAD with ECG How to Understand a Flow Curve?SVG to CX with ECG How to Understand a Flow Curve?SVG to RCA/PDA with ECG “Rules-of-Thumb”For Flow Measurements During CABG/OPCAB Study on Flowmetry During OPCABPatients and Results Study on Flowmetry During OPCAB Cause for the RevisionStudy on Flowmetry During OPCABThe Revisions with no Improvements Majority of the non-improved grafts are associated with poor run-off (low flow situations) 5 patients (7 revisions): 5 revisions with poor native vessel or dissection (4 SVG-RCA + 1 GEA-PDA) 1 revision impossible due to hematoma caused by stabilizer foot (LIMA-LAD) 1 non identified cause (LIMA-LAD) Flowmetry During Beating Heart Coronary SurgeryConversions to CPB and Reoperations 阜外医院 LIMA-LAD( 67 /80例) 平均血流量为25.00+/-18.0ml/min（2.2-70 ml/min） 119 根静脉桥,对角支22 根，36.8+/-18.6 ml/min（7-81 ml/min），钝缘支38根，40.3+/-25.0 ml/min（4-127 ml/min）。右冠状动脉50 根，38.0+/-14.7 ml/min（7-118 ml/min），后降支9根，25.5+/-14.7 ml/min（5.2-56.0 ml/min）。 搏动指数大于5有8例，平均血流量小5ml/min有6例，其中平均血流量小于5ml/min且搏动指数大于5有2例。 前降支远端血管情况与流量 （run off）   右冠状动脉远端血管情况与流量 两组术中不同旁路部位血流测量结果对比 两组冠状动脉弥漫病变与非弥漫病变血流测量对比 Clinical Case #1LIMA-LAD: proximal snaring technique: corrected anastomosis  Clinical Case #2Kinked SVG-RCA Clinical Case #2Kinked SVG-RCA: graft shortened by redoing the proximal anastomosis Clinical Case #3Intimal Flap SVG-RCA Clinical Case #3Intimal Flap SVG-RCA removed and dista