Early Adaptation of the Left Internal Thoracic Artery as a Blood Source of Y-Composite Radial Artery Grafts in Off-Pump Coronary Artery Bypass Grafting
Objective: Y-composite grafting with the radial artery (RA) is often used in off-pump coronary artery bypass grafting (OPCAB). However, the early flow reserve of the left internal thoracic artery (LITA) as a blood source of the Y-composite RA graft has not been delineated.
Methods: The size of the LITA was examined angiographically in 42 patients who underwent OPCAB using LITA and Y-composite RA grafting between June 2000 and February 2002. In these patients, the LITA was used as a blood source of the Y-composite RA graft. The mean patient age ± SD was 67 ± 8 years. The average number of distal anastomoses was 3.2 ± 0.7. Total coronary revascularization was carried out in 34 patients with only LITA and Y-composite RA grafting. RA grafting was used for revascularization of the circumflex artery alone in 5 patients, for the right coronary artery system (RCS) alone in 6 patients, and for both the circumflex and the RCS in 23 patients. The average number of distal anastomoses using the RA was 1.9 ± 0.7. Flow measurements of the proximal LITA were achieved intraoperatively with a transit-time flowmeter. The diameters of the LITA before and after the operation were measured angiographically. Intraoperative flow volume was correlated with the ratio of the LITA diameters before and after the operation.
Results: The mean flow rate of the LITA was 61 ± 35 mL/min (range, 9-196 mL/min). The mean diameters of the LITA before and after the operation were 1.97 ± 0.36 mm and 2.74 ± 0.60 mm, respectively. The mean ratio of the LITA diameter after the operation to that before the operation was 1.43 ± 0.27. The intraoperative flow volume was positively correlated with the ratio of LITA diameters (r = 0.414; P = .006). Conclusion: These results demonstrate the early adaptation of the LITA as a blood source of the Y-composite RA graft in OPCAB and the rationale for using the LITA as a single blood source for total coronary artery revascularization.
Acar C, Jebara VA, Portoghese M, et al. 1992. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 54:652-60.nCanver CC, Dame NA. 1994. Ultrasonic assessment of internal thoracic artery graft flow in the revascularized heart. Ann Thorac Surg 58:135-8.nD'Ancona G, Karamanoukian HL, Ricci M, Schmid S, Bergsland J, Salerno TA. 2000. Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 17:287-93.nDiegeler A, Hirsch R, Schneider F, et al. 2000. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg 69:1162-6.nElbeery JR, Brown PM, Chitwood WR Jr. 1998. Intraoperative MID-CAB arteriography via the left radial artery: a comparison with Doppler ultrasound for assessment of graft patency. Ann Thorac Surg 66:51-5.nHe GW, Acuff TE, Ryan WH, Mack MJ. 1994. Risk factors for operative mortality in elderly patients undergoing internal mammary artery grafting. Ann Thorac Surg 57:1453-61.nJaber SF, Koenig SC, BhaskerRao B, VanHimbergen DJ, Spence PA. 1998. Can visual assessment of flow waveform morphology detect anastomotic error in off-pump coronary bypass grafting? Eur J CardiothoracSurg 14:476-9.nArom FV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. 2000. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 69:704-10.nBorger M, Rao V, Weisel R, et al. 1998. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 65:1050-6.nCalafiore AM, Di Giammarco G, Luciani N, Maddestra N, Di Nardo E, Angelini R. 1994. Composite arterial conduits for a wider arterial myocardial revascularization. Ann Thorac Surg 58:185-90.nCalafiore AM, Di Giammarco G, Teodori G, et al. 1995. Radial artery and epigastric artery in composite grafts: improved midterm angiographic results. Ann Thorac Surg 60:517-23.nCalafiore AM, Di Mauro M, D'Alessandro, et al. 2002. Revascularization of the lateral wall: long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting. J Thorac Cardiovasc Surg 123:225-31.nCalafiore AM, Teodori G, Di Giammarco G, et al. 1999. Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg 67:450-6.nKramer A, Mastsa M, Paz Y, et al. 2000. Bilateral skeletonized internal thoracic artery grafting in 303 patients seventy years and older. J Thorac Cardiovasc Surg 120:290-7.nLesperance J, Campeau L, Reiber JH, et al. 1996. Validation of coronary artery saphenous vein bypass graft diameter measurements using quantitative angiography. Int J Card Imaging 12:299-303.nLouagie YA, Haxhe JP, Buche M, Schoevaerdts JC. 1994. Intraoperative electromagnetic flowmeter measurements in coronary artery bypass grafts. Ann Thorac Surg 57:357-64.nManiar HS, Sundt TM, Barner HB, et al. 2002. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovasc Surg 123:45-52.nMatata BM, Sosnowski AW, Galinanes M. 2000. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg 69:785-91.nNader ND, Khadra WZ, Reich NT, Bacon DR, Salerno TA, Panos AL. 1999. Blood product use in cardiac revascularization: comparison of on-and off-pump techniques. Ann Thorac Surg 68:1640-3.nWalpoth BH, Bosshard A, Genyk I, et al. 1998. Transit-time flow measurement for detection of early graft failure during myocardial revascularization. Ann Thorac Surg 66:1097-100.nWeinschelbaum EE, Gabe ED, Macchia A, Smimmo R, Suarez LD. 1997. Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg 114:911-6.nÖmeroglu SN, Kirali K, Güler M, et al. 2000. Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 70:844-50.nPoirier NC, Carrier M, Lesperance J, et al. 1999. Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass. J Thorac Cardiovasc Surg 117:292-7.nQuigley RL, Weiss SJ, Highbloom RY, Pym J. 2001. Creative arterial bypass grafting can be performed on the beating heart. Ann Thorac Surg 72:793-7.nRoyse AG, Royse CF, Groves KL, Bus B, Yu G. 1999. Blood flow in composite arterial grafts and effect of native coronary flow. Ann Thorac Surg 68:1619-22.nShin H, Yozu R, Mitsumaru A, et al. 2001. Intraoperative assessment of coronary artery bypass graft: transit-time flowmetry versus angiography. Ann Thorac Surg 72:1562-5.nSpeziale G, Ruvolo G, Coppola R, Marino B. 2000. Intraoperative flow measurement in composite Y arterial grafts. Eur J Cardiothorac Surg 17:505-8.n
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