Abstract
The aim of our study was to measure the flow in coronary artery bypass grafts and to compare the flow between two groups of patients. In group A the arterial revascularization was performed with both internal thoracic arteries using as a Y graft and in group B conventional revascularization using left internal thoracic artery (ITA) attached to the left anterior descending artery (LAD) and venous grafts to the other branches of the left coronary artery was performed. The flow in all grafts was measured at six time points during the operation. The cumulative flow at the end of the operation in the group A (arterial Y graft) was 51.8 +/- 24.5 ml/min and in group B (conventional technique) it was 96.8 +/- 41.1 ml/min (p < 0.05). The flow in left ITA to LAD was similar in both groups (27.3 +/- 15.9 ml/min and 26.3 +/- 16.1 ml/min in group A and B). The flow in right ITA (25.2 +/- 18.4 ml/min) was significantly lower than in venous grafts (72.5 +/- 45.5 ml/min). The calculated flow reserve was 2.2 in group A and 2.1 in group B. We found that the cumulative flow in arterial Y graft was lower in comparison with conventional revascularization. This is due to the lower flow in the right ITA branch of the Y graft compared to venous grafts. However based on clinical results, we can postulate that the flow in the Y graft is sufficient to meet the demand of the myocardium originally supplied by the left coronary artery.
Highlights
Myocardial revascularization in the left coronary artery territory using internal thoracic arteries is a well-established method based on clinical experience with excellent long-term results[1,2,3]
The flow in the right internal thoracic artery (ITA) and venous grafts i.e. the grafts bypassing the other diseased left coronary branches are shown in Tab. 2
Intraoperative measurement of the graft blood flow is a useful quality parameter for revealing technical errors and provides important hemodynamic information that can improve our knowledge of the physiological aspects of coronary artery bypass grafting (CABG)
Summary
Myocardial revascularization in the left coronary artery territory using internal thoracic arteries is a well-established method based on clinical experience with excellent long-term results[1,2,3]. The Y graft techniques have been developed with different free arterial conduits attached to the side of in situ left internal thoracic artery (ITA) that serves as a single inflow source. The right ITA or the radial arteries are the most often used conduits. Since often more than two distal anastomoses are required, a sequential grafting technique is adopted. Some doubts about the adequacy of the flow immediately after revascularisation may exist in such a technique. Little is known about the competition between blood flow in the grafts and native coronary arteries
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