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Journal of Cardiothoracic Surgery

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Open Access 01-12-2016 | Research article

Change in luminal diameter of the left internal thoracic artery anastomosed to the totally occluded left anterior descending coronary artery

Authors: Yochun Jung, Byoung Hee Ahn, Gwan Sic Kim, In Seok Jeong, Kyo Seon Lee, Sang Yun Song, Kook Joo Na, Sang Gi Oh

Published in: Journal of Cardiothoracic Surgery | Issue 1/2016

Abstract

Background

Coronary artery bypass grafting (CABG) with a composite Y-graft made of the left internal thoracic artery (LITA) and another arterial graft has a risk for hypoperfusion. Changes over time in the diameter of the LITA anastomosed to the left anterior descending coronary artery (LAD) are not known.

Methods

Data were collected for 71 patients who had undergone coronary angiography (CAG) immediately and at 1 year following off-pump CABG with a composite Y-graft made of the LITA and either the radial artery or the right gastroepiploic artery. These patients were divided into 2 groups depending on the degree of LAD stenosis. Group 1 (n = 28) consisted of patients with complete occlusion of the LAD. Group 2 (n = 43) consisted of patients with <90% stenosis of the LAD. The clinical state and luminal diameter of the LITA on immediate postoperative and postoperative 1-year CAG were compared and analyzed.

Results

On the immediate postoperative CAG, mean LITA diameter of Group 1 was larger than that of Group 2 (2.09 ± 0.53 vs. 1.61 ± 0.33 mm, P = 0.01). Mean LITA diameter 1 year following CABG was also larger in Group 1 than in Group 2 (2.49 ± 0.31 vs. 2.10 ± 0.45 mm, P = 0.005). Both groups showed significant increases in the LITA diameters at postoperative 1 year.

Conclusions

The LITA used as a composite Y-graft underwent remodeling, resulting in a larger diameter, to supply adequate myocardial blood. The degree of change in luminal diameter varied according to the severity of the LAD stenosis.

Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314:1–6.CrossRefPubMed

Sakaguchi G, Tadamura E, Ohnaka M, Tambara K, Nishimura K, Komeda M. Composite arterial Y graft has less coronary flow reserve than independent grafts. Ann Thorac Surg. 2002;74:493–6.CrossRefPubMed

Malenka DJ, Leavitt BJ, Hearne MJ, Robb JF, Baribeau YR, Ryan TJ, et al. Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. Circulation. 2005;112:I371–6.PubMed

Shimizu T, Ito S, Kikuchi Y, Misaka M, Hirayama T, Ishimaru S, et al. Arterial conduit shear stress following bypass grafting for intermediate coronary artery stenosis: a comparative study with saphenous vein grafts. Eur J Cardiothorac Surg. 2004;25:578–84.CrossRefPubMed

Barner HB, Barnett MG. Fifteen- to twenty-one-year angiographic assessment of internal thoracic artery as a bypass conduit. Ann Thorac Surg. 1994;57:1526–8.CrossRefPubMed

Nakayama Y, Sakata R, Ura M. Growth potential of left internal thoracic artery grafts: analysis of angiographic findings. Ann Thorac Surg. 2001;71:142–7.CrossRefPubMed

Loop FD, Thomas JD. Hypoperfusion after arterial bypass grafting. Ann Thorac Surg. 1993;56:812–3.CrossRefPubMed

Suma H. Internal thoracic artery and competitive flow. J Thorac Cardiovasc Surg. 1991;102:639–40.PubMed

Wendler O, Hennen B, Markwirth T, König J, Tscholl D, Huang Q, et al. T graft with the right internal thoracic artery to left internal thoracic artery versus the left internal thoracic artery and radial artery: flow dynamics in the internal thoracic artery main stem. J Thorac Cardiovasc Surg. 1999;11:841–8.CrossRef

10.

Akasaka T, Yoshikawa J, Yoshida K, Maeda K, Hozumi T, Nasu M, et al. Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire. J Am Coll Cardiol. 1995;25:640–7.CrossRefPubMed

11.

Markwirth T, Hennen B, Scheller B, Schafers HJ, Wendler O. Flow wire measurements after complete arterial coronary revascularization with T-grafts. Ann Thorac Surg. 2001;71:788–93.CrossRefPubMed

12.

Royse AG, Royse CF, Groves KL, Bus B, Yu G. Blood flow in composite arterial grafts and effect of native coronary flow. Ann Thorac Surg. 1999;68:1619–22.CrossRefPubMed

13.

Kemeda Y, Kitamura S, Taniguchi S, Kawata T, Mizuguchi K, Nishioka H, et al. Differences in adaptation to growth of children between internal thoracic artery and saphenous vein coronary bypass grafts. J Cardiovasc Surg. 2001;42:9–16.

14.

Barner HB. Remodeling of arterial conduits in coronary grafting. Ann Thorac Surg. 2002;73:1341–5.CrossRefPubMed

15.

Moncada S, Palmer RM, Higgs EA. Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev. 1991;43:109–42.PubMed

16.

Acar C, Ramsheyi A, Pagny JY, Jebara V, Barrier P, Fabiani JN, et al. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg. 1998;116:981–9.CrossRefPubMed

17.

Geary RL, Kohler TR, Vergel S, Kirkman TR, Clowes AW. Time course of flow-induced smooth muscle cell proliferation and intimal thickening in endothelialized baboon vascular grafts. Circ Res. 1994;74:14–23.CrossRefPubMed

18.

Barner HB. Blood flow in the internal mammary artery. Am Heart J. 1973;86:570–1.CrossRefPubMed

19.

Tagusari O, Kobayashi J, Bando K, Niwaya K, Nakajima H, Ishida M, et al. Early adaptation of the left internal thoracic artery as a blood source of y-composite radial artery grafts in off-pump coronary artery bypass grafting. Heart Surg Forum. 2003;6:E93–8.PubMed

20.

Sanidas EA, Mintz GS, Maehara A, Cristea E, Wennerblom B, Iniguez A, et al. Adverse cardiovascular events arising from atherosclerotic lesions with and without angiographic disease progression. JACC Cardiovasc Imaging. 2012;5 Suppl 3:S95–S105.CrossRefPubMed

21.

McMullan JT, Lindsell CJ, Blomkalns AL. Five-year mortality and coronary heart disease development after normal coronary angiogram. World J Emerg Med. 2011;2:24–9.CrossRefPubMedPubMedCentral

Title: Change in luminal diameter of the left internal thoracic artery anastomosed to the totally occluded left anterior descending coronary artery
Authors: Yochun Jung
Byoung Hee Ahn
Gwan Sic Kim
In Seok Jeong
Kyo Seon Lee
Sang Yun Song
Kook Joo Na
Sang Gi Oh
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2016
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-016-0554-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Change in luminal diameter of the left internal thoracic artery anastomosed to the totally occluded left anterior descending coronary artery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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