Flow capacity of internal mammary artery grafts: Early restriction and later improvement assessed by doppler guide wire

Akasaka, Takashi; Yoshikawa, Junichi; Yoshida, Kiyoshi; Maeda, Kenji; Hozumi, Takeshi; Nasu, Michihiro; Shomura, T

doi:10.1016/0735-1097(94)00448-y

Cited by 82 publications

(46 citation statements)

References 17 publications

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“…The functional behavior of the LITA graft to the left anterior descending artery has already been well described [18,19]. However, few authors explored the velocity and the quantity of the blood flow in composite arterial grafts.…”

Section: Commentsmentioning

confidence: 99%

“…Thus, there is no necessity of further handling (for the anastomosis of another graft) of the LITA One disadvantage of the use of composite arterial grafts is the dependence on the LITA for all the blood supply to the revascularized arteries. Thus, the capacity and reserve of the LITA to supply a quantity of blood sufficient for the revascularized area should be questioned [17].The functional behavior of the LITA graft to the left anterior descending artery has already been well described [18,19]. However, few authors explored the velocity and the quantity of the blood flow in composite arterial grafts.…”

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confidence: 99%

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<![CDATA[Coronary artery bypass grafting with composite grafts: comparison of blood flow to the left coronary artery with the conventional technique]]>

Neto¹,

Chaccur²,

Carvalho³

et al. 2004

Braz. j. cardiovasc. surg.

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Background: Composite grafting techniques for coronary artery bypass grafts (CABG) have been widely used. However, it remains unclear whether this technique provides similar blood flow to the left coronary artery when compared to the conventional alternative. We sought to compare the total blood flow to the left coronary branches that are revascularized with left internal thoracic (LITA) and radial artery (RA) grafts using composite and non-composite techniques.Method: A total of 42 patients were randomly assigned to three groups according to the CABG technique to be used: Group A or composite LITA-RA in a Y format (n=14); Group B or modified composite LITA-RA intercoronary graft with RA and LITA to RA at the left anterior descending artery (LADn=14)]; and Group C or pedicled LITA to the LAD and aortocoronary RA (n=14). The patients were submitted to postoperative blood flow velocity analysis using a 0.014 inch 12 MHz Doppler flowire. Coronary flow reserve (CFR) was calculated by determining the average hyperemic peak velocity (APV) after an injection of adenosine.Results: Proximal LITA baseline APV was 28.4 ± 4.8 cm/s in group A, 34.4 ± 7.9 cm/s in group B (p=0.0384 x C) and 25.8 ± 8.6 cm/s in group C. The CFR was 2.1 ± 0.4, 2.0 ± 0.3 and 2.0 ± 0.4 in groups A, B and C respectively (p=0.7208 A, B x C). The total Q to LCA branches was 110 ± 30 in group A, 145 ± 59 in B and 133 ± 58 mL/min in C (p=0.3232 A, B x C).Conclusions: The LITA-RA composite graft maintains an adequate CFR and conveys similar blood flow to the left coronary artery branches when compared with conventional CABG technique. The utilization of two internal thoracic arteries has given benefits [2], but this can be associated with a greater morbidity in obese and diabetic patients [3].The radial artery (RA), in spite of its easy dissection and handling, initially demonstrated unfavorable results as evidenced by cineangiography. However, with modifications in the surgical dissection technique, in the preparation and handling of the graft, the RA was safely reintroduced for the treatment of coronary artery disease [4]. This graft now gives good results over the long term [5][6][7].With experience, it seemed evident that the different sizes between the wall of the RA and the wall of the ascending aorta could compromise the proximal anastomosis of the graft.Based on works of anastomosis of the right internal thoracic artery (RITA) in the LITA [8][9][10], some surgeons started to anastomose the RA proximally to the left internal thoracic artery, to revascularize the branches of the left coronary artery (LC) [11] giving the same results in the postoperative period when compared to the RITA under the same conditions [12,13] or the RA anastomosed proximally to the aorta [7].In composite arterial grafts, all the blood flow (Q) distributed to the revascularized arteries is from the LITA. This can lead to the question about if the blood flow available from the LITA is enough to irrigate the myocardium or, if in the composite arterial grafting techni...

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Section: Commentsmentioning

confidence: 99%

mentioning

confidence: 99%

<![CDATA[Coronary artery bypass grafting with composite grafts: comparison of blood flow to the left coronary artery with the conventional technique]]>

Neto¹,

Chaccur²,

Carvalho³

et al. 2004

Braz. j. cardiovasc. surg.

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“…13, 14 However, the ITA graft can adapt to the higher flow demands of the relevant myocardial area, thus resulting in an increased graft diameter, usually identifiable within 1 month. [15][16][17][18][19] Many studies on the coronary flow reserve of the ITA graft after pharmacological intervention with adenosine, dipyridamole, papaverine, and nitroglycerin, …”

Section: Physiological and Metabolic Effects Of Grafts In Cabgmentioning

confidence: 99%

Physiological and Metabolic Effects of Grafts in Coronary Artery Bypass Surgery

Kitamura

2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary artery bypass grafting (CABG) surgery initially utilizing a saphenous vein graft (SVG) and later the internal thoracic artery (ITA) has gained world-wide acceptance as a highly effective operation that not only ameliorates angina pectoris, but also improves both cardiac function and patient longevity. On the other hand, percutaneous coronary intervention (PCI) utilizing metallic or drug-eluting stents has also obtained rapid and world-wide popularity as a less invasive method of treating coronary artery obstructive disease, and many randomized clinical trials (RCT) are being conducted to compare the efficacy of CABG vs. PCI from the various clinical aspects of the different grades of illness. The endpoints of the trials include the occurrence of death, myocardial infarction, cerebral stroke and need for reintervention.I have long questioned why an ITA -left anterior descending artery (LAD) bypass can prolong a patient's life better than a SVG -LAD bypass, 1-3 why the use of bilateral ITAs can prolong life better than unilateral use, 4,5 and why CABG using the ITA can prolong life better than PCI in specific groups of patients, such as those with diabetes and elderly patients with triple-vessel disease, as has been demonstrated in the recent prospective RCT or retrospective risk-matched clinical studies. 6-9Furthermore, I have long considered that there are fundamental benefits of CABG with the use of ITAs, not only due to graft patency alone, but also due to differences in the endothelial metabolic effects of the ITA, SVG and coronary stents, particularly in patients with severe coronary endothelial dysfunction, such as multivessel coronary artery disease, 8 elderly patients 9 and diabetic patients. 6,7 Here, I review previous publications on these topics, while focusing on the physiological and metabolic function of the graft transplanted into the coronary artery systems by CABG surgery. Intraoperative Graft Flow and Postoperative Coronary Flow ReserveThe ITA graft flow is about 50-60% of the SVG flow when measured intraoperatively by electromagnetic flow meter 10 or a transit-time Doppler flow meter. 11 The limited flow of the ITA graft is attributed to its small luminal caliber and the length of the graft originating from the subclavian artery; both of which result in higher physiologic conduit resistance than with the SVG, which has a larger lumen and shorter length, usually originating from the ascending aorta. When CABG is performed under cardiopulmonary bypass and anoxic cardiac arrest, ITA malperfusion syndrome 12 occurs very rarely, which is when the ITA graft flow cannot meet the increased post-cardiac arrest hyperemic flow demand. In this setting, either a pharmacological or surgical addition is required to compensate for the hypoperfusion. Pharmacologically, an increase in the perfusion pressure and relief from coronary and/or graft spasm are necessary, and can be achieved with the administration...

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“…Internal mammary artery is superior for its long tern patency rates, whereas saphenous vein graft being larger caliber vessel achieves superior flow dynamics in the early post-operative period. 13 Although many studies have demonstrated the long term advantage of using mixed (Left internal Mammary artery + venous conduits) over pure venous conduits in terms of graft patency, a very few studies have compared left ventricular function, the incidence of post-operative complications and the mean duration of hospital stay in both these groups. The present study aimed to compare the above-mentioned parameters in both the groups.…”

Section: Introductionmentioning

confidence: 99%

A comparison of left ventricular function in patients undergoing beating heart bypass surgery using mixed versus pure venous conduits

et al. 2017

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Background: The pathophysiology of coronary artery disease was established in 1876 by Adam Hammer when he postulated that angina is caused by interruption of coronary blood supply and that myocardial infarction occurred after the occlusion of at least one coronary artery. Aims of the study were to compare the left ventricular function in patients who have undergone beating heart bypass surgery using mixed (internal mammary artery and venous conduits) versus pure Venous conduits, and to compare the incidence of postoperative complications.Methods: It was an observational, analytical study. All patients admitted with triple vessel disease requiring CABG (n=50), with ejection fraction >30%, were subjected to either left internal mammary artery and venous conduits (group A, n=25) or only venous conduits (group B, n=25). Patient who had undergone prior surgical myocardial revascularization, preexisting valvular disease, any evidence of raised pulmonary arterial pressure more than 40/15 mmHg, operated using cardiopulmonary bypass machine, pre-operative use of Intra-Aortic Balloon Pump, any history of neurological dysfunction/Transient ischemic attack, left atrium size more than 5.5 cm were excluded from the studyResults: Improvement in left ventricular function after coronary artery bypass grafting was objectively demonstrated in both the groups. There was a statistically significant increase in mean LVEF in group B (56.16±4.13) compared to group A (51.96±5.30) at 3 months of follow up (p=0.009). The most common complication in both the groups were atrial fibrillation group A=36% (n=9), group= B 16 % (n=4), renal failure group A=12% and group B=8% and sternal wound infection. The post-operative bleeding (Drain output) in first 24 hours was similar in both the groups, 295.56 ml in group A and 265.20ml in group B (p=) with similar hospital stay (group A=9days, group B=8.5days).Conclusions: Patients with venous conduits have better postoperative LVEF as compared to Mixed conduit with similar rate of post-operative complications.

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Flow capacity of internal mammary artery grafts: Early restriction and later improvement assessed by doppler guide wire

Cited by 82 publications

References 17 publications

<![CDATA[<b>Coronary artery bypass grafting with composite grafts</b>: <b>comparison of blood flow to the left coronary artery with the conventional technique</b>]]>

<![CDATA[<b>Coronary artery bypass grafting with composite grafts</b>: <b>comparison of blood flow to the left coronary artery with the conventional technique</b>]]>

Physiological and Metabolic Effects of Grafts in Coronary Artery Bypass Surgery

A comparison of left ventricular function in patients undergoing beating heart bypass surgery using mixed versus pure venous conduits

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