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[Physiological characteristics of arterial graft for coronary artery bypass surgery]
T Tedoriya1, M Kawasuji, N Sakakibara
1Department of Surgery, School of Medicine, Kanazawa University.
Insights
Arterial grafts used in coronary artery bypass grafting (CABG) show lower diastolic pressure and flow compared to the aorta. This suggests arterial grafts may be less physiologically suitable for the heart
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Hemodynamics
Context:
- Coronary artery bypass grafting (CABG) frequently utilizes arterial grafts for their long-term patency.
- Concerns exist regarding potentially inadequate blood flow within arterial grafts compared to aorto-coronary bypass grafts.
- Understanding graft hemodynamics is crucial for optimizing surgical outcomes.
Purpose:
- To quantitatively assess and compare blood pressure dynamics in arterial grafts versus the ascending aorta during CABG.
- To evaluate the physiological suitability of arterial grafts for coronary circulation based on pressure wave analysis.
Summary:
- Pressure measurements were taken in the ascending aorta (AA), internal thoracic artery (ITA), and gastroepiploic artery (GEA) grafts during CABG.
- Arterial grafts exhibited narrow systolic pressure waves and rapid diastolic pressure decline, with GEA showing lower diastolic pressure than ITA.
- Diastolic areas under the pressure wave were significantly lower in ITA and GEA compared to AA, indicating reduced diastolic flow in grafts.
Impact:
- Arterial grafts, originating from systolic-dominant circulation, present physiological disadvantages for the diastolic-dominant coronary circulation.
- Findings highlight potential limitations of arterial grafts in matching the hemodynamic environment of coronary arteries.
- This research informs the selection and potential modification of grafts for improved CABG efficacy.
Abstract:
Arterial grafts have been used widely for coronary artery bypass grafting (CABG) because of their excellent long patency. However, some clinical reports suggest that blood flow in arterial grafts may not be adequate compared with aorto-coronary bypass grafting. Pressure in arterial grafts was measured in patients undergoing CABG. The pressure tracing in the ascending aorta (AA) was maintained during diastole. The systolic pressure wave in ITA and GEA was narrow, while the diastolic pressures fell rapidly: the diastolic pressure in GEA was lower than in ITA. The area under the pressure wave was measured in diastole and in systole. Although there was no significant difference in systolic areas, the diastolic area were lower in ITA than in AA, and lower in GEA than in AA and in ITA. These results clarified that arterial grafts which belong to the systolic-dominant systemic circulation have disadvantages over aorto-coronary bypass grafts, in terms of physiological suitabilities to the diastolic-dominant coronary circulation.