Biomechanics of coronary artery and bypass graft disease: potential new approaches.
The contribution of biomechanical factors to the incidence and distribution of coronary artery and bypass graft disease is underrecognized. This review examined the literature to determine which factors were relevant and the evidence for their importance. It identified two primary biomechanical factors that predispose to disease: (1) low-wall shear stress and (2) high-wall mechanical stress or strain. A range of secondary biomechanical factors have also been identified and include: vessel geometry; vessel movement; vessel wall characteristics and the presence of reflection waves. Potential surgical approaches for minimizing these effects are discussed.
John
Lindsay C H
LC
Department of Cardiothoracic Surgery, Kings College Hospital, London, United Kingdom. lindsay.john@kch.nhs.uk
D000714:Anastomosis, Surgical / Q000009:adverse effects; D001696:Biomechanical Phenomena; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects; D008297:Male; D012307:Risk Factors; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation; D012680:Sensitivity and Specificity; D033081:Shear Strength; D013314:Stress, Mechanical; D014654:Vascular Patency / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology