| Factors affecting internal mammary artery graft survival: how is competitive flow from a patent native coronary vessel a risk factor? | |
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MedLine Citation:
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PMID: 9299287 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Recent studies have suggested that competitive flow is an important factor in early internal mammary artery (IMA) graft failure. Flow competition from minimally diseased native coronary vessels has been implicated in the failure of IMA grafts, but does not seem to affect saphenous vein grafts (SVG). The objective of this study was to determine the effects of competitive flow on SVG and IMA grafts and to compare the patterns of flow dynamics and pressure on proximal and distal grafts to the left anterior descending (LAD) artery; factors that may be involved in graft failure. Twelve mongrel dogs underwent coronary artery bypass grafting using IMAs and a SVG to an open LAD artery. The right IMA (PIMA) and the SVG were anastomosed in the proximal LAD and the left IMA (DIMA) was anastomosed at a more distal location. The procedure was performed through a left thoracotomy, using an "off pump" technique. Graft flows were measured isolated and in competition. The IMAs and SVG provided flow levels similar to the native LAD when each one was the sole inflow to the LAD. During competitive flow conditions, total and diastolic SVG flows were reduced 54.4 and 50.5%, respectively (P < 0.05). Total and diastolic PIMA and DIMA flows were reduced more drastically (68.6-73.3 and 69.5-68.1%, respectively; P < 0.05). The DIMA had better preservation of diastolic flow compared to PIMA. A delay in the pressure wave was noted in the isolated IMAs, but not in the SVG. This pattern of flow disappeared during competition due to the large, systolic retrograde flow up the IMA grafts. In conclusion, IMAs compared to the SVG are longer and narrower conduits with lower levels of flow during competition. Low levels of flow and oscillating flow (retrograde/ antegrade) may be poorly tolerated by the IMA endothelium and may be factorial to graft failure. These data suggest that a more distal placement of the IMA graft may be protective to the arterial graft under competitive flow conditions. |
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Authors:
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S Pagni; J Storey; J Ballen; W Montgomery; N K Qaqish; S Etoch; P A Spence |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of surgical research Volume: 71 ISSN: 0022-4804 ISO Abbreviation: J. Surg. Res. Publication Date: 1997 Aug |
Date Detail:
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Created Date: 1997-10-09 Completed Date: 1997-10-09 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376340 Medline TA: J Surg Res Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 172-8 Citation Subset: IM |
Copyright Information:
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Copyright 1997 Academic Press. |
Affiliation:
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Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky 40202, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Coronary Circulation* Dogs Graft Survival Myocardial Revascularization* Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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