Different graft flow patterns due to competitive flow or stenosis in the coronary anastomosis assessed by transit-time flowmetry in a porcine model☆☆☆

Nordgaard, Håvard B.; Nordhaug, Dag; Kirkeby‐Garstad, Idar; Løvstakken, Lasse; Vitale, Nicola; Haaverstad, Rune

doi:10.1016/j.ejcts.2009.02.036

Cited by 32 publications

(21 citation statements)

References 21 publications

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“…Furthermore, the differences of TAWSS and OSI between the lower competitive flow (75% stenosis) condition and no competitive flow (100% stenosis) condition were slight. This indicated that lower competitive flow resulted in TAWSS and OSI similar to the no-competitive flow condition, which agreed well with Nordgaard's reports [2]. Unfortunately, when the stenosis was lower than 75%, the TAWSS decreased and OSI increased fast towards an unbeneficial situation.…”

Section: Discussionsupporting

confidence: 90%

“…Nordgaard et al assessed whether coronary graft flow patterns are affected differently by native coronary competitive flow or by stenosis of the coronary anastomosis based on nine pigs underwent off-pump grafting of the left internal thoracic artery to the left anterior descending artery (LAD). And it was concluded that the mammary graft flow was significantly reduced by native coronary competitive flow, but marginally decreased by a stenotic anastomosis of 75% mean luminal stenosis [2]. Kawamura et al studied the effect of competitive flow on patency rate of the internal thoracic artery to the left anterior descending artery bypass from the concomitant saphenous vein (SV) graft in the left coronary artery, based on 313 patients who had two bypasses to the left coronary artery including 1 in situ ITA-LAD graft.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model

Ding

Liu²,

Wang³

et al. 2012

Computational and Mathematical Methods in Medicine

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Competitive flow from native coronary artery is considered as a major factor in the failure of the coronary artery bypass grafts. However, the physiological effects are not very clear. The aim is to research the impact of competitive flow caused by different left anterior descending (LAD) artery stenosis degrees on hemodynamics in internal thoracic artery (ITA) bypass graft. An idealized ITA-LAD model was built in CAD tools. The degree of the competitive flow was divided into five classes according to different LAD stenosis degrees: higher (no stenosis), secondary (30% stenosis), reduced (50% stenosis), lower (75% stenosis) and no competitive flow (fully stenosis). Finite volume method was employed for the numerical simulation. The flow velocity distributions, wall shear stress and oscillatory shear index were analyzed. Results showed that higher competitive flow in the bypass graft would produce unbeneficial wall shear stress distribution associating with endothelial dysfunction and subsequent graft failure. The coronary bypass graft surgery was preferred to be carried out when the LAD stenosis was higher than 75%.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model

Ding

Liu²,

Wang³

et al. 2012

Computational and Mathematical Methods in Medicine

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“…This could be expected, as WSS is dominated mainly by the flow rate and the mean diameter of the vessel (Box et al, 2005). The flow depends mostly on the degree of competitive flow and stenosis of the distal anastomosis (Nordgaard et al, 2009(Nordgaard et al, , 2010. This result is evidence that the improvement in WSS parameters is not a result of graft narrowing, but a result of improvement in graft geometry.…”

Section: Discussionmentioning

confidence: 54%

Numerical analysis of Venous External Scaffolding Technology for Saphenous Vein Grafts

Meirson

Orion²,

Avrahami

2015

Journal of Biomechanics

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“…The flow pattern in a bypass graft should also mainly be diastolic as in a coronary artery. One of the most important causes of reduction of graft flow is native coronary flow competition, which mainly happens in the diastole [20]. The good flow reserve in semiskeletonized group (F4) is then, a favorable effect, especially in the presence of competitive coronary flow.…”

Section: Discussionmentioning

confidence: 99%

A randomized comparison of flow characteristics of semiskeletonized and pedicled internal thoracic artery preparations in coronary artery bypass

Satdhabudha

Noppawinyoowong

2017

J Cardiothorac Surg

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BackgroundHarvesting the internal thoracic artery (ITA) with semiskeletonization is an alternative technique between conventional wide pedicle and skeletonization. It is almost as simple as pedicle harvesting; however, it is supposed to provide the advantage of graft flow and length. Since the heart is unique being the only organ which is perfused during diastole, for comparing the intraoperative graft flow characteristics of semiskeletonization and pedicle technique, we used diastolic filling (DF) using transit-time flow measurement as a primary result. The objective of this study is to compare if semiskeletonized ITA has a greater effect on the intraoperative DF of graft flow versus conventional pedicled ITA in coronary artery bypass.MethodsBetween July 2015 and May 2016, a prospective evaluation of 60 consecutive patients undergoing coronary artery bypass grafting for left anterior descending artery revascularization were randomized to having semiskeletonized (n = 30) or conventional pedicled (n = 30) ITA graft harvested by the same surgeon. Intraoperative transit-time flows were obtained. The DF of the ITA graft at the end of operation was evaluated in two groups.ResultsThe intraoperative DF was significantly greater in the semiskeletonized grafts than in the pedicled grafts (70.50 ± 14.15 versus 57.6 ± 19.39%; p = 0.005). No statistical difference was observed comparing quantitative pulsatile flow and pulsatile index at the end of the operation in the two groups. However, the free flow of the conduit during the cardiopulmonary bypass before the anastomosis performed was greater in semiskeletonized group than in pedicled group (94 ± 48.37 versus 56.35 ± 34.90 ml/min; p = 0.003). The total operative time was comparable between two groups (p = 0.092).ConclusionsSemiskeletonized ITA resulted in superior DF of left anterior descending bypass graft flow as compared with pedicled ITA. It is also provide a greater free flow and length of the graft without the long-delayed operative time.Trial registrationTrial registration number (Study ID): TCTR20160913002 Date of registration: September 10, 2016

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Different graft flow patterns due to competitive flow or stenosis in the coronary anastomosis assessed by transit-time flowmetry in a porcine model☆☆☆

Cited by 32 publications

References 21 publications

Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model

Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model

Numerical analysis of Venous External Scaffolding Technology for Saphenous Vein Grafts

A randomized comparison of flow characteristics of semiskeletonized and pedicled internal thoracic artery preparations in coronary artery bypass

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