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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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