Original ArticlesBlood flow in composite arterial grafts and effect of native coronary flow
Section snippets
Material and methods
Seventeen patients underwent total arterial coronary revascularization, using a composite graft in which a radial artery was anastomosed to the LIMA near its third intercostal branch [5]. Grafts to all three coronary territories were performed using these two conduits. Sequential anastomoses were constructed as required (Fig 1). In no patients was an aortic anastomosis done, or a vein graft used. The Royal Melbourne Hospital Human Ethics Committee approved the study, and all patients gave
Results
The 17 patients underwent coronary artery bypass operation to all three coronary artery territories. All patients underwent elective operation using a pedicled Y graft technique [5], without concomitant procedures. No patient was excluded based on conduit size or severity of coronary disease. There were 13 men and 4 women. Their mean age was 63 ± 2 years, and mean body surface area was 1.86 ± 0.03 m2. The mean number of distal anastomoses was 3.9 ± 0.2 (range 3 to 5). Mean cardiopulmonary
Comment
In the quest to perform routine total arterial revascularization, composite Y graft methods are gaining popularity 3, 4, 9, 10. All patients in this study had revascularization of all three coronary territories using a composite arterial graft based on the LIMA, which remains attached to the subclavian artery (pedicled). No supplementary grafts were used.
Our data show that construction of a Y graft using RA led to an increase of 74 mL/min in total LIMA pedicle flow (Table 2). The resultant
Acknowledgements
The authors wish to acknowledge Dr John Ludbrook (Biomedical Statistical Consulting Pty Ltd) for his assistance with the statistical analysis and manuscript review and the contribution of Mr James Tatoulis and Prof Duncan W. Blake.
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2011, Annals of Thoracic SurgeryCitation Excerpt :These results have also been confirmed at all time points of the follow-up. Our data are in agreement with those of Royse and associates [15], who reported an intraoperative 2.3-fold reserve of composite mammary and RA grafts, and with those of Afflek and colleagues [3], who found a flow reserve of 1.6, computed as the ratio of free flow over completion flow, which was considered adequate for flow requirements in the early postoperative period. Lemma and coworkers [4] reported that composite Y-grafts can efficiently adapt to increased flow demand induced by atrial pacing early after operation.