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J Thorac Cardiovasc Surg 2008;136:876-883
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Vascular adaptation of the internal thoracic artery graft early and late after bypass surgery

^a Cardiovascular Surgery, University Hospital, Geneva, Switzerland
^b Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland

Received for publication September 26, 2007; revisions received April 18, 2008; accepted for publication May 19, 2008.

^_* Address for reprints: Beat H. Walpoth, MD, Cardiovascular Research, Geneva University Hospital, 1211 Geneva 14, Switzerland. (Email: beat.walpoth{at}hcuge.ch).

Objective: Flow mismatch between the supplying artery and the myocardial perfusion region has been observed in patients with internal thoracic artery grafts. Thus coronary flow changes of arterial (internal thoracic artery grafts) and saphenous (saphenous vein grafts) bypass grafts were studied early and late after coronary artery bypass grafting.

Methods: Thirty patients undergoing elective bypass surgery (internal thoracic artery and saphenous vein grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow.

Results: Intraoperatively, internal thoracic artery graft flow was significantly lower than saphenous vein graft flow (31 ± 8 vs 58 ± 29 mL/min, P < .01). Postoperatively, internal thoracic artery graft flow increased significantly to 42 ± 24 mL/min at 3 months and to 56 ± 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein graft flow remained unchanged over time (58 ± 29 to 50 ± 27 mL/min at 3 months and 46 ± 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic artery (1.3 ± 0.3) and saphenous vein (1.6 ± 0.5) grafts but increased significantly to normal values in both types of graft at follow-up.

Conclusions: Bypass flow of the internal thoracic artery graft is significantly reduced intraoperatively when compared with that of the saphenous vein graft. However, 3 and 10 months after the operation, flow of the internal thoracic artery graft increases significantly and is similar to saphenous vein graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic artery, probably because of endothelium-mediated mechanisms.