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The Journal of Cardiovascular Surgery 2001 December;42(6):793-7

language: English

Should the supplemental vein graft be anastomosed upstream or downstream of the internal thoracic artery (ITA) for ITA hypoperfusion?

Otaki M., Inoue T., Oku H.

From the Depart­ment of Car­di­o­vas­cular Sur­gery Kinki Uni­ver­sity Hos­pital, ­Osaka, ­Japan


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Back­ground. ­This ­study was ­designed to com­pare ­internal tho­racic ­artery (ITA) ­flow in dif­ferent set­tings of sup­ple­mental ­vein ­grafting for ITA hypo­per­fu­sion.
­Methods. Four­teen ­dogs ­each ­received two cor­o­nary ­bypass ­grafts to the cir­cum­flex ­artery (CFX), ­using ­left ITA and ­vein ­grafts, and ­then the prox­imal CFX was ­ligated. The ani­mals ­were ­divided ­into two ­groups. G-I ­dogs ­receiving the ­vein ­graft prox­i­mally to the ITA ­graft and G-II ­receiving the ­vein dis­tally. ITA ­flow was eval­u­ated ­regarding 1) ­effects of com­pe­ti­tion ­from the ­vein ­graft, and 2) phar­mac­o­log­ical or phys­io­log­ical ­effects on the ­ITA’s con­tri­bu­tion to ­distal per­fu­sion. ­Flow is ­expressed as a ­mean (ml/min).
­Results. ITA ­flow was 44.2±5.9 in G-I, and 45.7±6.5 in G-II (p=ns), ­when the ­vein ­graft was ­occluded. ­With a ­vein ­graft ­open, ITA ­flow ­decreased to 7.5±1.6 in G-I, and 6.8±1.8 in G-II (p=ns), and ­ITA’s con­tri­bu­tion to ­total per­fu­sion require­ments was 18% in G-I and 16% in G-II. Aden­o­sine (0.2 mg/min/kg) ­increased the ITA ­flow in ­both ­groups, 18.4±3.2, and 16.3±3.8, respec­tively (p=ns), and ­ITA’s con­tri­bu­tion to ­distal per­fu­sion was ­increased to 32% in G-I and 27% in G-II. In con­trast, phen­y­leph­rine (0.003 mg/min/kg) ­decreased ITA ­flow and ­ITA’s con­tri­bu­tion to ­distal ­flow in ­both ­groups (6.1±1.1, 11% vs 6.2±1.4, 11%, p=ns), but ­increased ­vein ­flow sig­nif­i­cantly. Car­diac ­pacing (150 bpm) ­increased the ITA ­flow and ­ITA’s con­tri­bu­tion to ­distal per­fu­sion ­equally in ­both ­groups (8.4±1.5, 16% vs 7.6±2.6, 15%, p=ns).
Con­clu­sions. Sup­ple­mental ­vein ­grafting, ­whether it is ­placed dis­tally or prox­i­mally, ­limits ITA ­flow and ­ITA’s con­tri­bu­tion to ­distal per­fu­sion ­both in the ­resting ­heart and ­during the ­increased myo­car­dial ­oxygen ­demand.

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