Does Moderate Coronary Stenosis Affect the Fate of the Left Internal Thoracic Artery Graft?
Aytac Caliskan1, Ertekin Utku Unal2, Emre Kubat3
1Cigli District Training Hospital, Cardiovascular Surgery, Izmir, Turkey.
Insights
This study found that the functional rate of left internal thoracic artery grafts used in coronary artery bypass grafting was lower than previously reported. Doppler ultrasonography assessed graft patency and patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Interventional Cardiology
Background:
- The left internal thoracic artery (LITA) is a preferred arterial graft for coronary artery bypass grafting (CABG) to the left anterior descending artery (LAD).
- Assessing long-term graft patency is crucial for patient outcomes.
- Fractional flow reserve (FFR) guides revascularization decisions in moderate stenosis.
Purpose of the Study:
- To evaluate the long-term fate of LITA grafts to the LAD in patients selected by FFR.
- To assess graft functionality using Doppler ultrasonography.
- To correlate graft patency with clinical outcomes.
Main Methods:
- A cohort of 30 patients undergoing CABG based on FFR results were evaluated.
- Transthoracic color Doppler ultrasonography was used to assess LITA graft patency.
- Graft flow patterns were analyzed using a supraclavicular approach.
Main Results:
- The LITA graft was functional in 63.3% of patients at a mean follow-up of 35.1 months.
- Functional grafts showed a significant reduction in angina symptoms (88.9% to 16.7%, P<0.001).
- Dysfunctional grafts also showed symptom improvement (90.9% to 36.4%, P=0.034), but less pronounced.
Conclusions:
- The observed functional LITA graft rate in this FFR-guided CABG cohort was lower than reported in existing literature.
- Doppler ultrasonography is a viable noninvasive method for assessing LITA graft patency.
- Further research is needed to understand factors contributing to lower graft patency rates.
Introduction:
In this study we try to observe the fate of the left internal thoracic artery grafts that were bypassed to left anterior descending artery with moderate stenosis identified with fractional flow reserve (FFR) technique. Doppler ultrasonography was chosen as a noninvasive screening method.
Methods:
A total of 30 patients who underwent coronary artery bypass grafting depending on results of the fractional flow reserve between January 2007 and January 2012, were subjected to transthoracic color Doppler ultrasonographic evaluation irrespective of the presence of symptoms, and the presence of a systolic-diastolic flow pattern was investigated using the supraclavicular approach.
Results:
The left internal thoracic artery graft was found to be functional in 63.3% of patients within a mean period of 35.1±19.7 months between coronary bypass and color Doppler ultrasonography. This period was found to be 29.4±19.6 months in the functional graft group, and 44.7±16.6 months in the dysfunctional graft group (P=0.046). Preoperative complaints of angina were reported to fall from 88.9% to 16.7% in the functional graft group, when compared to the postoperative period (P<0.001), but fell from 90.9% to 36.4% in the dysfunctional graft group (P=0.034).
Conclusion:
Functional left internal thoracic artery graft rates of the study population were found to be lower than the studies reported in the literature.
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