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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2002 October;43(5):625-31

lingua: Inglese

The axillocoronary bypass. Blood flow and short-term graft histology in a porcine model

Bonatti J. 1, Hangler H. 1, Oturanlar D. 1, Posch L. 1, Sieb M. 1, Salvador S. 1, Krismer A. 2, Voelckel W. 2, Schwarz B. 2, Lingnau W. 2, Klima G. 3, Mairinger T. 4, Coulson A. S. 5

1 Depart­ments of Sur­gery/Car­diac Sur­gery
2 Anes­thesia and Gen­eral Inten­sive ­Care Med­i­cine
3 His­tology and Embry­ology
4 Pathology Inns­bruck Uni­ver­sity Hos­pital, Innsbruck, Austria
5 Cape Fear Valley Medical Center Fayetteville, NC, USA


Back­ground. ­Bypass ­grafts ­arising ­from the axil­lary ­artery may be indi­cated for com­pli­ca­tions ­during min­i­mally inva­sive ­direct cor­o­nary ­artery ­bypass ­grafting, for ­redo oper­a­tions and for man­age­ment of a ­severely ath­e­ros­cle­rotic ­ascending ­aorta. As ­basic ­data ­research on ­this tech­nique is ­scanty, we inves­ti­gated intra­op­er­a­tive func­tion and post­op­er­a­tive mor­phology of axil­lo­cor­o­nary ­bypass ­grafts in a por­cine ­model.
­Methods. Thir­teen ­German ­domestic ­pigs ­received an axil­lo­cor­o­nary ­vein ­graft (­Group I, n=7) or an aor­to­cor­o­nary ­vein ­graft (­Group II, n=6) to the ­left ante­rior ­descending ­artery. In ­Group I the prox­imal anas­tom­osis was per­formed to the ­left axil­lary ­artery, and ­after par­tial rib resec­tion the ­graft was ­brought trans­pleu­rally to the ­target ­vessel. In ­both ­groups the cor­o­nary anas­tom­osis was car­ried out on the ­beating ­heart ­without car­di­o­pul­mo­nary ­bypass. ­Graft ­flow was meas­ured ­using ­transit ­time ultra­sonic ­flow ­probes.
­Results. Intra­op­er­a­tively all ­grafts ­showed a typ­ical dia­stolic ­flow pro­file. ­Stable ­graft ­flow was ­lower in axil­lo­cor­o­nary ­bypass ­grafts: 47 (30-60 mL/min) in ­Group I and 65 (35-126 mL/min) in ­Group II (p=0.005). ­Flow ­given as per­centage of car­diac ­output, how­ever, did not ­differ ­between the two ­grafts: 0.9 (0.6-1.2%) in ­Group I and 1.2 (0.8-2.4%) in ­Group II (p=NS). At day 4 ­after sur­gery ­there was no ­clear his­to­logic pred­i­lec­tion ­site for micro­trauma and ­early degen­er­a­tive ­changes in the axil­lo­cor­o­nary ­graft.
Con­clu­sions. Axil­lo­cor­o­nary ­bypass ­flow com­pares ­well ­with ­flow in the aor­to­cor­o­nary ­graft. Micro­trauma ­after implan­ta­tion and ­early degen­er­a­tive ­changes in the axil­lo­cor­o­nary ­vein ­bypass are not par­tic­u­larly ­impacted by the tho­racic ­entry ­site.

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