Authors
Shevchenko Yu.L.1, Sidorov V.V.2, Mamadaliev D.M.1, Miminoshvili L.G.1, Ulbashev D.S.1, Malsagova D.B.1
1 St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
2 Scientific and production enterprise “LAZMA”, Moscow
Abstract
Coronary heart disease occupies a leading position in the structure of causes of death and disability of the adult population. In the Russian Federation, there is an increase in the number of surgical revascularizations, which requires improved methods of intraoperative quality control of coronary bypass surgery. Despite the use of ultrasound Doppler flowmetry as the “gold standard” for assessing the patency of shunts, this method does not allow us to characterize the restoration of perfusion at the microcirculatory level, which is especially important for the prevention of perioperative myocardial infarction. Laser Doppler flowmetry is a promising method for intraoperative monitoring of cardiac microcirculation, however, the amount of published data in this area remains limited, which determines the need for further study of the features of myocardial perfusion during coronary bypass surgery.
Aim. Improving the results of coronary bypass surgery by improving the control of revascularization effectiveness by direct assessment of myocardial perfusion.
Materials and methods. To assess microcirculation, laser Doppler flowmetry was used to determine the main diagnostic parameters, such as M (average blood perfusion in the microcirculation system), Mnutr (average nutritional blood flow or fraction of blood flow through capillaries) and Mbypass (part of blood flow through arteriovenous anastomoses). Definitive control of bypass surgery efficiency was carried out by ultrasonic Doppler flowmetry.
Results. In most cases, the increase in total perfusion (ΔМ) after myocardial revascularization was 20%. This moderate increase is explained by the initially low microcirculation rates in the areas of ischemic myocardium. A detailed analysis revealed that the increase in nutritional (capillary) blood flow (ΔМnutr) was more pronounced and reached 60%, which indicates the restoration of blood supply to the heart. At the same time, bypass blood flow (Mbypass) parameters remained stable. A comparison of laser Doppler flowmetry with the results of ultrasound Doppler flowmetry of shunts showed that an increase in average perfusion was observed only when the volumetric blood flow rate through the shunts was ≥25 ml/min.
Conclusion. The study confirms the effectiveness of using laser Doppler flowmetry for intraoperative assessment of myocardial perfusion during coronary bypass surgery. Further improvement of measurement methods and technical support will allow us to consider this method as a leading tool for quality control of myocardial revascularization.
Keywords: coronary artery disease, coronary bypass surgery, microcirculation, laser Doppler flowmetry, ultrasound Doppler flowmetry, revascularization efficiency.
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