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J Thorac Cardiovasc Surg 2000;119:125-129
© 2000 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

CLINICAL RESULTS OF CORONARY ARTERY BYPASS GRAFTING WITH USE OF THE INTERNAL THORACIC ARTERY UNDER LOW FREE FLOW CONDITIONS

Mitsumasa Hata, MDa, Motomi Shiono, MDa, Yukihiko Orime, MDa, Shinya Yagi, MDa, Tomonori Yamamoto, MDa, Haruhiko Okumura, MDa, Shun-ichi Kimura, MDa, Akira Sezai, MDa, Satoshi Kashiwazaki, MDa, Shinsuke Choh, MDa, Nanao Negishi, MDa, Yukiyasu Sezai, MDa, Eise Yokoyama, PhDb, Hiroaki Hata, MDc

From the Second Department of Surgerya and Public Health,b Nihon University School of Medicine, Tokyo, and The Department of Cardiovascular Surgery,c Okaya Enrei Hospital, Nagano, Japan.

Part of this study was presented at the seventieth meeting of the American Heart Association, Orlando, Fla, 1997.

Address for reprints: Mitsumasa Hata, MD, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan (E-mail: mihata{at}med.nihon-u.ac.jp).

Objective: Even when left internal thoracic artery flow is very low, we have used the artery for grafting without any further maneuvers. In this study, we investigated the clinical results of coronary bypass surgery using the left internal thoracic artery with low free flow.
Methods: A total of 163 patients were divided into 2 groups: group L (n = 43) had free flow of 20 mL/min or less and group H (n = 120) had free flow of more than 20 mL/min. We performed a comparative study on the basis of coronary angiography and pulsed Doppler echocardiography. Furthermore, 12 months’ postoperative graft angiography was carried out in 11 patients from group L.
Results: No patient had low output syndrome or perioperative myocardial infarction. One month after the operation, 3 cases of graft occlusion and 9 cases of the "string sign" were identified in group H. However, group L had no graft occlusion and only 1 case of the "string sign." The 1-month postoperative Doppler echocardiographic study showed no significant differences in the diastolic fraction of velocity time integrals and the diastolic/systolic peak velocity ratio of the grafts. In the 11 patients undergoing angiography after 1 year, graft patency was excellent. Moreover, the graft diameter was significantly larger than it was 1 month after the operation.
Conclusion: These results suggest that the left internal thoracic artery can be used for coronary artery bypass grafting even when the flow is less than 20 mL/min.




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 Ann. Thorac. Surg.Home page
M. Hata, M. Shiono, T. Inoue, A. Sezai, N. Negishi, and Y. Sezai
Midterm results of coronary artery bypass graft surgery with internal thoracic artery under low free-flow conditions
Ann. Thorac. Surg., August 1, 2004; 78(2): 477 - 480.
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