Endothelial Shear Stress of the Saphenous Vein Composite Graft Based on the Internal Thoracic Artery

Abstract

Endothelial shear stress (ESS) has been suggested as a factor affecting atherosclerosis and remodeling of native vessels and bypass conduits. We compared ESS levels of internal thoracic artery (ITA) and saphenous vein (SV) composite grafts intraoperatively and 1 year after coronary artery bypass grafting (CABG). Intraoperative ESS was calculated by measuring flow volumes and diameters of proximal and distal ITAs and SV conduits in 23 patients who received SV Y-composite grafts based on the in situ left ITA. Early (1.2 ± 0.5 days) and 1-year (12.9 ± 1.1 months) postoperative angiograms were performed in 23 and 15 patients, respectively. An intragraft Doppler-guidewire study for ESS measurement was performed in 6 patients during 1-year angiography. Intraoperative diameters of proximal and distal ITAs and SV conduits were 2.0 ± 0.2 mm, 1.8 ± 0.3 mm, and 3.2 ± 0.4 mm, respectively. ESS levels were significantly different between them (41.0 ± 21.0, 28.4 ± 25.2, and 4.3 ± 3.0 dyne/cm2, respectively). Proximal and distal ITA diameters increased significantly on early angiograms and remained unchanged, but SV diameter increased to 3.7 mm (95% confidence interval, 3.5 to 4.0 mm; p < 0.001) on the early angiogram and decreased to 2.9 mm (95% confidence interval, 2.7 to 3.2 mm; p < 0.001) at 1 year. Significant correlations were found between the initial ESS and proportional changes in conduit diameters during postoperative year 1. SV ESS increased in all 6 patients at 1 year, with no significant differences in ESS levels between the 3 conduits (29.9 ± 7.9, 28.8 ± 7.9, and 21.6 ± 16.3 dyne/cm2, respectively). Initial ESS appears to be associated with proportional changes in conduit diameters in the first year after CABG. ESS values of SV composite grafts were similar to left ITA conduits 1 year after CABG.