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[A quantitative angiographic study of characteristics of internal thoracic artery grafts in coronary artery bypass
T Seki1, K Kawachi, S Kitamura
1Department of Surgery III, Nara Medical University, Kashihara, Japan.
Insights
Internal thoracic artery (ITA) grafts show excellent flow adaptability and growth potential in pediatric patients. In adults, ITA graft diameter correlates with coronary artery stenosis severity, indicating suitability for coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Pediatric Cardiology
Abstract:
In adult patients with atherosclerotic coronary artery disease and in pediatric patients with Kawasaki heart disease, characteristics of internal thoracic artery grafts (ITA grafts) used for coronary artery bypass grafting (CABG) were quantitatively assessed by postoperative angiography. In 142 adult patients with a ITA graft for the left anterior descending artery (LAD), the diameter ratio between ITA graft and recipient LAD at the point close to the anastomotic site (ITA/LAD diameter ratio) was determined by postoperative angiography. This ratio for the adult patients as a whole was 1.04 +/- 0.34. The multivariate analysis (Quantification I) was performed to assess the effects of the following 12 factors on the ITA/LAD diameter ratio: (1) age at the time of operation, (2) sex, (3) time-duration from the operation to angiography, (4) laterality of the ITA used, (5) presence of an undivided major side branch of the ITA graft, (6) presence of blood flow competition between the ITA graft and other grafts, (7) presence of distal stenosis of the recipient LAD, (8) severity of LAD stenosis after the operation, and (9-12) presence of hyperlipidemia, diabetes mellitus, hypertension, or smoking history. The standardized category scores of 25% LAD stenosis, 50% LAD stenosis, and blood flow competition between the ITA and other grafts were -0.815, -0.359, and -0.306, respectively. Insignificant stenosis of the recipient coronary artery was associated with reduction of the ITA/LAD diameter ratio, and this ratio strongly correlated with the severity of LAD stenosis (partial correlation coefficient: 0.627). However, no other factors significantly influenced on the ITA/LAD diameter ratio. In 15 pediatric patients, the length and diameter of 19 ITA grafts and 5 saphenous vein grafts (SVGs) which remained patent in the early (about one month) and late (14 +/- 4 months) postoperative period were determined. Only in the ITA graft, increases in graft length and diameter associated with patient growth were recognized. In the present study, the physiological characteristics of the ITA graft were demonstrated as a viable conduit with flow adaptability and growth potential.