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Published on: November 24, 2014
Measurement of the flow in coronary artery bypass grafts
Petr Nemec1, Vilem Bruk, Andrea Steriovsky
1Department of Cardiac Surgery, Faculty of Medicine, Palacký University, University Hospital, Olomouc, Czech Republic. petr.nemec@fnol.cz
Insights
Arterial Y grafts showed lower cumulative flow than conventional bypasses, but clinical results suggest sufficient myocardial perfusion. This study compares arterial Y grafts versus traditional methods for coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Techniques
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Internal thoracic artery (ITA) grafts are preferred for arterial revascularization due to superior long-term patency.
- Comparing different arterial grafting strategies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To measure and compare blood flow in coronary artery bypass grafts between two surgical techniques.
- To evaluate the efficacy of arterial Y grafts versus conventional CABG using ITA and venous grafts.
Main Methods:
- Prospective study comparing two groups: Group A (bilateral internal thoracic arteries as a Y graft) and Group B (conventional CABG with left ITA and venous grafts).
- Blood flow in all grafts was measured at six intraoperative time points.
- Cumulative flow and flow reserve were calculated for each graft type.
Main Results:
- Cumulative intraoperative flow was significantly lower in the arterial Y graft group (51.8 ml/min) compared to the conventional group (96.8 ml/min) (p < 0.05).
- Flow in the left ITA to the left anterior descending artery was similar between groups.
- Flow in the right ITA was significantly lower than in venous grafts, impacting overall Y graft flow.
Conclusions:
- While cumulative arterial Y graft flow was lower than conventional bypasses, the flow reserve was comparable.
- The reduced flow in the right ITA component of the Y graft contributed to the lower overall cumulative flow.
- Despite lower measured flow, clinical results suggest that arterial Y grafts provide sufficient myocardial perfusion for the supplied territory.
Abstract:
The aim of our study was to measure the flow in coronary artery bypass grafts and to compare the flow between two groups of patients. In group A the arterial revascularization was performed with both internal thoracic arteries using as a Y graft and in group B conventional revascularization using left internal thoracic artery (ITA) attached to the left anterior descending artery (LAD) and venous grafts to the other branches of the left coronary artery was performed. The flow in all grafts was measured at six time points during the operation. The cumulative flow at the end of the operation in the group A (arterial Y graft) was 51.8 +/- 24.5 ml/min and in group B (conventional technique) it was 96.8 +/- 41.1 ml/min (p < 0.05). The flow in left ITA to LAD was similar in both groups (27.3 +/- 15.9 ml/min and 26.3 +/- 16.1 ml/min in group A and B). The flow in right ITA (25.2 +/- 18.4 ml/min) was significantly lower than in venous grafts (72.5 +/- 45.5 ml/min). The calculated flow reserve was 2.2 in group A and 2.1 in group B. We found that the cumulative flow in arterial Y graft was lower in comparison with conventional revascularization. This is due to the lower flow in the right ITA branch of the Y graft compared to venous grafts. However based on clinical results, we can postulate that the flow in the Y graft is sufficient to meet the demand of the myocardium originally supplied by the left coronary artery.
