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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1999 December;40(6):857-9

language: English

Flow capac­ity of infe­ri­or epi­gas­tric ­artery in com­pos­ite arte­ri­al ­grafts

Speziale G., Speziali G.*, Ruvolo G., Marino B.

From the Department of Cardiac Surgery, “La Sapienza” University School of Medicine, Rome, Italy
*Mayo Clinic and Foundation, Rochester, MN-USA

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Background. In the ­effort to ­expand the use of arte­ri­al con­duits for myo­car­dial revas­cu­lar­iza­tion, ‘Y-­graft’ tech­niques are uti­lized ­with increas­ing fre­quen­cy, ­although the phys­iol­o­gy of ­this ­type of com­pos­ite arte­ri­al ­grafts is not yet ful­ly under­stood. The aim of ­this ­study was to meas­ure chang­es in ­blood ­flow ­through a ‘Y-­graft’ con­struct­ed by anas­to­mos­ing a seg­ment of infe­ri­or epi­gas­tric ­artery (IEA) off the ­side of an in ­situ inter­nal tho­rac­ic ­artery (ITA).
Methods. Twenty-two ­patients who under­went ­CABG ­were ­enrolled in ­this pros­pec­tive ­study. Exclusion cri­te­ria ­were age > 70 ­years, ­poor ­left ven­tric­u­lar func­tion (Ejection Fraction < 0.25) and ­need for asso­ciat­ed car­diac pro­ce­dures. Blood ­flow in the ITA-IEA ‘Y-­graft’ was meas­ured in the oper­at­ing ­room ­after com­ple­tion of ­left ITA to ­left ante­ri­or descend­ing ­artery (LAD) and IEA to mar­gi­nal or diag­o­nal ­branch anas­to­mos­es. Follow-up eval­u­a­tion was per­formed at 3 and 12 ­months post­op­er­a­tive­ly.
Results. After com­ple­tion of sur­gery, ­blood ­flow in ITA and IEA as meas­ured down­stream ­from the Y anas­tom­o­sis was 45±7 and 39±6 ml/min respec­tive­ly. Temporary occlu­sion of ­either ­branch did not sig­nif­i­cant­ly ­affect ­flow in the oth­er ­side of the arte­ri­al Y. All ­patients ­were dis­charged ­from the hos­pi­tal in excel­lent con­di­tion. At fol­low-up no cas­es of angi­na recur­rence ­were record­ed.
Conclusions. Composite ITA-IEA arte­ri­al ­grafts pro­vide excel­lent ­short-­term clin­i­cal ­results. Blood ­flow on ­either ­side is not affect­ed by run off in the oth­er ­side ­branch. Information ­from ­this ­study may be ­used to under­stand the ­role ­that undi­vid­ed ITA ­side branch­es ­play in reduc­ing ­flow ­rate in an ITA ­graft har­vest­ed dur­ing min­i­mal­ly inva­sive ­CABG pro­ce­dures.

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