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Blood flow characteristics of the bilateral internal thoracic artery: implications of optimal graft configuration for coronary artery bypass grafting to maximize blood supply

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Abstract

Purpose

There is controversy regarding which internal thoracic artery (ITA) should be anastomosed to the left anterior descending artery (LAD). Here, we propose an optimal graft design based on measurement of blood flow in the ITA.

Methods

Sixty-one patients (53 men, median age 68 [62–75] years) undergoing first elective coronary artery bypass grafting were enrolled. Fifty-seven left ITAs (LITAs) and 28 right ITAs (RITAs) were harvested in either a semi-skeletonized manner using a harmonic scalpel covered with papaverine-soaked gauze (group-A, n = 45) or a fully skeletonized manner using electrocautery with intraluminal papaverine injection (group-B, n = 41). Free flow of 33 ITAs was measured after pharmacological dilatation and in situ ITA-LAD flow was measured in 59 patients by transit-time flowmetry.

Results

RITA and LITA free flow were 147.0 [87.8–213.0] mL/min and 108.0 [90.0–144.0] mL/min, respectively (P = 0.199). The group-B had significantly higher ITA free flow (135.0 [102.0–171.0] mL/min) than group-A (63.0 [36.0–96.0] mL/min, P = 0.009). In 13 patients with bilateral ITA harvesting, free flow of the RITA (138.0 [79.5–204.0] mL/min) was also significantly higher than the LITA (102.0 [81.0–138.0] mL/min, P = 0.046). There was no significant difference between RITA and LITA flow anastomosed to the LAD. The group-B had significantly higher ITA-LAD flow (56.5 [32.3–73.6] mL/min) than group-A (40.9 [20.1–53.7] mL/min, P = 0.023).

Conclusion

RITA provides significantly higher free flow than LITA but similar blood flow to the LAD. Full skeletonization with intraluminal papaverine injection maximizes both free flow and ITA-LAD flow.

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Authors and Affiliations

  1. Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Takashi Kunihara

  2. Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Yasushige Shingu & Satoru Wakasa

  3. Department of Cardiovascular Surgery, NTT EAST Medical Center Sapporo, Sapporo, Japan

    Hiroshi Sugiki

  4. Department of Cardiovascular Surgery, Kushiro City General Hospital, Kushiro, Japan

    Yasuhiro Kamikubo

  5. First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Norihiko Shiiya

  6. Department of Cardiovascular Surgery, Hanaoka Seishu Memorial Cardiovascular Clinic, Sapporo, Japan

    Yoshiro Matsui

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  1. Takashi Kunihara
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Kunihara, T., Shingu, Y., Wakasa, S. et al. Blood flow characteristics of the bilateral internal thoracic artery: implications of optimal graft configuration for coronary artery bypass grafting to maximize blood supply. Gen Thorac Cardiovasc Surg 71, 552–560 (2023). https://doi.org/10.1007/s11748-023-01930-x

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