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Die Biocompound-Gefäßprothese in der aorto-koronaren Bypasschirurgie

The biocompound graft prosthesis in coronary artery bypass surgery

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Zeitschrift für Herz-, Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Für die Koronarrevaskularisation wurden varilös-ektatisch veränderte Venen bisher wegen ungünstiger Strömungsdynamik und hohen Verschlußraten nicht verwendet. Die Verarbeitung der patienteneigenen Vene zum Biocompound-Graft, d. h. zu einer hochflexiblen Hybridprothese, verbessert das Strömungsprofil im Bypass in entscheidender Weise. Beim Biocompound-Graft wird die Vene mit einem feinsten ultraflexiblen Geflecht intraoperativ ummantelt und mit diesem mit Fibrinkleber verbunden. Der Netzschlauch wird mit Hilfe eines Applikationssets über die varikös-ektatisch veränderte Vene gezogen. Bei 80 Patienten (35 Frauen, 45 Männer), bei denen keine Möglichkeit der Verwendung alternativer Bypässe bestand, kam das Biocompound-Graft als aortokoronarer Bypass zur Anwendung. In 17 Fällen wurde die Operation notfallmäßig, bei 8 Patienten eine Reoperation durchgeführt. Sieben Patienten waren wegen Polymorbidität und des schlechten Venenstatus bereits von anderen Zentren abgelehnt worden. Durchschnittlich wurden 3,1±0,9 Bypässe angelegt (138 Biocompounds, 65 Venen, 45 Aa. thoracicae int., insgesamt 248 Bypässe). Das Follow-up beträgt 9,3±4,4 Monate (Maximum 24 Monate, Minimum 2 Monate). 79 von 80 Patienten konnten nachkontrolliert werden. Die Frühverschlußrate betrug 6,5%. Die Frühmortalität lag bei 3,8% (3 Patienten mit autoptisch offenen Bypässen in allen Fällen). Es traten keine Graftinfekte auf. Eine Patientin wurde 5 Monate postoperativ wegen eines technischen Anastomosenproblems reoperiert. Während des Follow-up’s verstarben 6 Patienten. Die Ursache war in 2 Fällen kardial, in weiteren 2 Fällen pulmonal. Ein Patient verstarb an einer Sepsis, bei einem Patienten ist die Todesursache unbekannt. 79,6% der Patienten beurteilten ihren Zustand besser als präopertiv, 85,7% benötigen keine Nitrate mehr. Die Resultate belegen bei dieser Gruppe polymorbider und operationstechnisch schwieriger Fälle die Einfachheit und Sicherheit der Methode. Das Biocompound-Graft bietet dem Chirurgen die Möglichkeit, bei Mangel an alternativen Bypässen varikös-ektatische Venen zu verwenden.

Summary

The use of varicose-ectatic veins as graft material in bypass surgery is unsatisfactory due to their unfavorable flow dynamics and high closure rates. Creating a biocompound graft with the patients’s vein enables the surgeon to use a simple technique to influence the bypass graft’s flow profile. A biocompound graft is created by encasing intraoperatively the vein in an extremely fine ultraflexible metal mesh and joining the two with fibrin glue. The mesh hose is pulled over the entire length of the vein with the aid of an application set. Biocompound grafts were used for aortocoronary bypass in 80 patients (35 women, 45 men) for whom no alternative graft was available. Seventeen patients were operated under emergency conditions. Redosurgery was performed on eight patients. Seven patients had been refused treatment at other facilities. An average of 3.1±0.9 bypass grafts were used (138 biocompound, 65 saphenous veins, 45 internal thoracic arteries, 248 bypasses altogether). The follow-up period was 9.3±4.4 months (maximum 24 months, minimum 2 months). The follow-up included 79 of 80 patients. Incidence of early bypass-closure was 6.5%. In-hospital mortality was 3.8% (three patients). In each case autopsy proved the bypasses being patent. No incidence of graft infection was observed. A female patient was reoperated 5 months postoperatively due to a technical anastomosis problem. There were six late deaths (two cardiac death, two pulmonary failures, one sepsis, one unknown). At follow-up 79.6% of the patients judged their cardiac condition to be better than before the operation and 85.7% were free of nitrate usage. In conclusion, the results prove the simplicity and reliability of this method in technically difficult cases. The biocompound graft gives the surgeon the possibility of using varicose-ectatic veins as bypass graft material if no alternative graft is available.

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  1. Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin

    H. R. Zurbrügg, M. Wied, K. Wenzel & R. Hetzer

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Zurbrügg, H.R., Wied, M., Wenzel, K. et al. Die Biocompound-Gefäßprothese in der aorto-koronaren Bypasschirurgie. Z. Herz-, Thorax-, Gefäßchir. 11, 28–36 (1997). https://doi.org/10.1007/BF03043235

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