PDF(Pubmed)
Abstract：
Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. \"No-Touch\" harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.
摘要：
冠状动脉旁路移植术（CABG）是并将继续成为多支血管疾病患者的首选血运重建策略。移植物选择已显示影响CABG后的结果。在过去的近60年中，隐静脉移植物（SVG）与乳内动脉一起已成为接受CABG手术的患者的护理标准。虽然这些好处几乎没有疑问，通畅率一直在争论中。尽管由于内膜增生在长期通畅方面存在公认的局限性，隐静脉仍然是最常用的移植物。尽管术后早期发生再内皮化，内膜增生的过程仍然是不可逆的。这部分是由于高剪切力的持久性，慢性局部炎症反应，和再生内皮的部分功能失调。“无触”收获技术，特定的存储解决方案，压力控制的移植物冲洗和外支架置入术是重要的既定方法，旨在克服不同时间水平的内膜增生过程。尽管有已知的证据，但这些方法并非到处都是标准的。使用动脉移植物是解决低SVG通畅率和进行CABG和全动脉血运重建的另一种策略。复合嫁接,药理学药物以及最新的微创技术的目标在同一方向。为提供指导和制定标准，CABG的所有移植物相关主题均在有关移植物治疗的专家意见文件中介绍。
