Adequacy of flow capacity of bilateral internal thoracic artery T graft

Ochi, Masami; Hatori, Nobuo; Bessho, Ryuzo; Fujii, Masahiro; Saji, Yoshiaki; Tanaka, Shigeo; Honma, Hiroshi

doi:10.1016/s0003-4975(01)03201-5

Cited by 21 publications

(11 citation statements)

References 19 publications

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“…Despite studies demonstrating that the LITA is capable of providing adequate blood flow for two or more LCS arteries, both in baseline situation and in stress [9,10,12] , other authors report that composite Y-grafts might present lower CFR than independent grafts [13] . CFR, defined as blood flow under stress divided by blood flow in baseline condition, is an effective parameter to evaluate if the graft is capable of providing adequate blood flow in a situation of higher demand.…”

Section: Discussionmentioning

confidence: 99%

“…CFR, defined as blood flow under stress divided by blood flow in baseline condition, is an effective parameter to evaluate if the graft is capable of providing adequate blood flow in a situation of higher demand. Previous studies show that the LITA in composite grafts increases its diameter [12,21] and flow supply [9,10,22] , which means that it presents a morphological and functional adaptation, in addition to possessing a CFR appropriate to supply the myocardium, with values similar to the ones of single grafts [9,10,21] . Our study noted that, even in early situations, such as just after the confection of anastomosis, there is a statistically significant increase in blood flow of the LITA proximal segment and of other branches of the composite graft after pharmacological stress.…”

Section: Discussionmentioning

confidence: 99%

“…Even though it has been demonstrated that the LITA is capable of providing adequate blood flow for two or more arteries from the left coronary system (LCS) [10,12] , there is still concern about the possibility of hypoperfusion [13] . There is still concern that the presence of the secondary graft of GSV can reduce blood flow in the LITA distal segment, due to phenomena of competition or steal of flow [14] .…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Filho¹,

Filho²,

Pimentel³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveComposite graft of left internal thoracic artery and great saphenous vein in revascularization of the left coronary system is a technique well described in literature. The aim of this study is to analyze blood flow dynamics in this configuration of composite graft especially in what concerns left internal thoracic artery's adaptability and influence of great saphenous vein segment on left internal thoracic artery's flow.MethodsRevascularization of left coronary system with composite graft, with left internal thoracic artery revascularizing the anterior interventricular artery and a great saphenous vein segment, anastomosed to the left internal thoracic artery, revascularizing another branch of the left coronary system, was performed in 23 patients. Blood flow was evaluated by transit time flowmetry in all segments of the composite graft (left internal thoracic artery proximal segment, left internal thoracic artery distal segment and great saphenous vein segment). Measures were performed in baseline condition and after dobutamine-induced stress, without and with non-traumatic temporary clamping of the distal segments of the composite graft.ResultsPharmacological stress resulted in increase of blood flow values in the analyzed segments (P<0.05). Non-traumatic temporary clamping of great saphenous vein segment did not result in statistically significant changes in the flow of left internal thoracic artery distal segment, both in baseline condition and under pharmacological stress. Similarly, non-traumatic temporary clamping of left internal thoracic artery distal segment did not result in statistically significant changes in great saphenous vein segment flow.ConclusionComposite grafts with left internal thoracic artery and great saphenous vein for revascularization of left coronary system, resulted in blood flow dynamics with physiological adaptability, both at rest and after pharmacological stress, according to demand. Presence of great saphenous vein segment did not alter physiological blood flow dynamics in distal segment of left internal thoracic artery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Filho¹,

Filho²,

Pimentel³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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“…OCHI et al [16], in 2001, performed a study in 40 patients with the aim of evaluating the capacity of the LITA to provide adequate flow to two or more arteries of the LCS. In all the studied patients, the LITA presented an increase of the diameter of its lumen and in the echocardiographic examination under stress, ventricular contraction abnormalities in the revascularized regions were not observed.…”

Section: Commentsmentioning

confidence: 99%

Revascularização miocárdica com enxerto composto de artéria torácica interna esquerda em Y: análise de fluxo sangüíneo

Filho¹,

Leitão²,

Filho³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To assess the left internal thoracic artery (LITA) flow pattern, when it was used to supply the left anterior descending artery (LADA) and another branch from the left coronary artery system (LCAS).Methods: In the following study, the left internal thoracic artery flow was investigated by echocardiography Doppler, at rest and under dobutamine stress, in two twenty-patient groups. Group A consisted of patients who received only a pedicled LITA graft to the LADA. Group B consisted of patients who received a pedicled LITA graft associated with a vein graft to supply the LADA and another artery from the LCAS. The angiographic study showed graft patency in all patients from both groups. The following parameters were used: systolic flow (SF), diastolic flow, total flow, total flow in stress/ total flow at rest ratio (TFS/TFR), systolic peak velocities (SPV), diastolic peak velocities and systolic peak velocity/ diastolic peak velocity ratio.Results: All analyzed parameters were considered statistically significant, except SF, TFS/TFR and SPV.Conclusions: We concluded that in the same conditions and methodology, the LITA flow in the composite graft (group B) is higher than in the free graft (group A), which shows the great flow adaptability of the LITA to respond to flow demand.

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“…In the 1990s, followed by the current decade, several authors have published articles in numerous series of patients undergoing CABG with composite grafts, in which the LITA was the only source of blood supply to two or more coronary arteries [2][3][4][5]. Over the same period, we also demonstrated in a series of cases that the LITA is capable of providing adequate blood supply for the entire LCS, in times of rest and under stress, without both CPB support and MAA [5,6].…”

Section: Introductionmentioning

confidence: 99%

Enxerto composto de artéria torácica interna esquerda e veia safena magna: estudo angiográfico após oito anos

Filho

Filho²,

Mesquita

et al. 2010

Rev Bras Cir Cardiovasc

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Enxerto composto de artéria torácica interna esquerda e veia safena magna: estudo angiográfico após oito anosLeft internal thoracic artery and saphenous vein as a composite graft: 8-year angiographic follow-up study AbstractThe use of a composite graft of left internal thoracic artery (LITA) with arterial or saphenous vein (SV) segments can allow complete revascularization of the left coronary system (LCS) without cardiopulmonary bypass (CPB) and without ascending aorta manipulation (AAM), in order to reduce some complications in the immediate postoperative period. This study shows 8-year angiographic follow-up results of two patients underwent no-touch aorta off-pump coronary artery bypass grafting (CABG) using LITA and SV as a composite graft to supply LCS. Resumo O uso de enxerto composto de artéria torácica interna esquerda (ATIE) com segmentos arteriais ou segmentos de veia safena magna (VSM) pode permitir a revascularização completa do sistema coronariano esquerdo (SCE) sem circulação extracorpórea (CEC) e sem manuseio da aorta ascendente (MAA), como forma de tentar reduzir alguns riscos e complicações no pós-operatório imediato. Neste trabalho, relatamos os resultados angiográficos, após oito anos, de dois pacientes submetidos à cirurgia de revascularização do SCE com enxerto composto de ATIE e VSM, sem CEC e sem MAA.Descritores: Revascularização miocárdica. Angiografia coronária. Artéria torácica interna. Veia safena. 119LOBO FILHO, JG ET AL-Left internal thoracic artery and saphenous vein as a composite graft: 8-year angiographic follow-up study Rev Bras Cir Cardiovasc 2010; 25(1): 118-121 cinecoronarioangiography, which showed patency of both grafts, directing attention to the absence of radiological signs indicative of atheromatosis in venous graft in all projections (Figure 1). After conservative treatment, the patient was discharged with a clinical picture of compensated heart failure.

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Adequacy of flow capacity of bilateral internal thoracic artery T graft

Cited by 21 publications

References 19 publications

Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Revascularização miocárdica com enxerto composto de artéria torácica interna esquerda em Y: análise de fluxo sangüíneo

Enxerto composto de artéria torácica interna esquerda e veia safena magna: estudo angiográfico após oito anos

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