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Flow characteristics of LIMA radial composite sequential bypass grafting and single LIMA and saphenous vein

J S Jung1, C H Chung, S H Lee

  • 1Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea.

The Journal of Cardiovascular Surgery
|August 3, 2012
PubMed

Insights

Composite bypass grafting using the radial artery shows inferior hemodynamic flow compared to traditional single LIMA and saphenous vein grafts in off-pump coronary artery bypass grafting. Further studies are needed to confirm long-term graft durability.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Grafting
  • Hemodynamics

Background:

  • Off-pump coronary artery bypass grafting (OPCAB) is a surgical technique used to bypass blocked coronary arteries without using cardiopulmonary bypass.
  • Graft selection is crucial for long-term patency and patient outcomes.
  • The left internal thoracic artery (LITA) and radial artery (RA) are commonly used arterial grafts, while the saphenous vein (SV) is a frequently used venous graft.

Purpose of the Study:

  • To compare the hemodynamic flow characteristics of LIMA-radial artery composite sequential bypass grafting with single LIMA and saphenous vein sequential bypass grafting during OPCAB.
  • To evaluate the efficacy of different arterial and venous graft configurations in maintaining optimal blood flow.

Main Methods:

  • A prospective study involving 121 OPCAB patients divided into two groups: Group I (LITA-LAD and Ao-SV sequential grafting) and Group II (LITA-RA sequential grafting).
  • Hemodynamic parameters including mean flow, pulsatility index (PI), and backflow (BF) were measured using a Transit-time flow meter (TTFM).
  • In Group II, proximal and distal LITA flows were measured separately relative to the RA anastomosis.

Main Results:

  • The radial artery (RA) graft in Group II exhibited significantly lower mean flow (27.3 mL/min) and higher pulsatility index (PI) (4.1) compared to the saphenous vein (SV) graft in Group I (64.4 mL/min, PI 2.6).
  • In Group II, distal LITA flow (18.8 mL/min, PI 3.9) was lower than proximal LITA flow (37.3 mL/min, PI 2.3), indicating potential flow compromise.
  • Both LITA and RA grafts in Group II showed significantly different flow characteristics compared to the LITA-SV grafts in Group I (P<0.01).

Conclusions:

  • Composite LIMA-radial artery sequential bypass grafting demonstrates inferior hemodynamic flow characteristics compared to a strategy using single LIMA and separate aorta-SV bypass grafting.
  • The findings suggest potential challenges with the composite grafting technique in maintaining optimal graft perfusion.
  • Longer follow-up is necessary to determine the clinical implications of these hemodynamic differences on graft durability and long-term outcomes.
Abstract

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