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J Thorac Cardiovasc Surg 2003;126:1076-1079
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Immediate flow reserve of Y thoracic artery grafts: an intraoperative flowmetric study

^a Department of Cardiology and Cardiac Surgery, "G. D'Annunzio" University, Chieti, Italy

Received for publication July 18, 2002; revisions received September 3, 2002; revisions received December 2, 2002; accepted for publication December 19, 2002.

^* Address for reprints: Antonio Maria Calafiore, MD, "G. D'Annunzio" University, Division of Cardiac Surgery, c/o S. Camillo de' Lellis Hospital, via C. Forlanini, 50, 66100, Chieti, Italy
calafiore{at}unich.it

OBJECTIVES: Use of both internal thoracic arteries in a Y graft configuration can raise concerns about the possibility of the single left internal thoracic artery being able to meet the flow requirements of two or three distal territories. We evaluated intraoperatively the flow reserve of a Y thoracic artery graft distally anastomosed to the anterior and lateral territories.

METHODS: In 21 patients who had Y thoracic artery grafts, the flow was measured in the main stem of the left internal thoracic artery, in the left internal thoracic artery branch, and in the right internal thoracic artery. A transit time Doppler flowmeter was used. Measurements were repeated after the injection of a bolus of 20 µg/kg dobutamine.

RESULTS: At baseline condition, the mean blood flow was 44.8 ± 24.2, 23.4 ± 11.5, and 21.4 ± 15.3 mL/min in the main stem of the left internal thoracic artery, in the left internal thoracic artery branch, and in the right internal thoracic artery, respectively. After dobutamine injection, these values increased to 93.2 ± 49.8, 46.1 ± 22.6, and 42.5 ± 31.2 mL/min, respectively. Flow reserve was 2.1 ± 0.6, 2.2 ± 0.9, and 2.1 ± 0.9 mL/min, respectively.

CONCLUSIONS: Intraoperative injection of dobutamine increases the flow in the Y thoracic graft by more than two times, not only in the main stem but also in each branch. This finding attests to the safety of Y thoracic conduits in terms of hemodynamic potential.

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