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J Thorac Cardiovasc Surg 2005;130:1494-1495
© 2005 The American Association for Thoracic Surgery

Editorial

Does the internal thoracic artery graft have self-reparative ability?

National Cardiovascular Center, Osaka, Japan

^_* Address for reprints: Soichiro Kitamura, MD, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan (Email: skitamur@hsp.ncvc.go.jp).

The first 20% of the full text of this article appears below.

Accumulating clinical ^1-3 and basic ^4,5 evidence with regard to the internal thoracic artery (ITA) as a viable graft has revealed that this arterial graft for coronary bypass surgery is not a simple conduit to transport blood to the myocardium. It has a character of the major collateral pathway ⁶ with active biologic potency, such as immunity from the atherosclerotic process, active dilatation and resultant arterial wall remodeling, excellent endothelial secretion of nitric oxide and other biologically active substances, active thinning (string phenomenon) with no-flow patency (nonworking collateral vessel), reestablishment of graft flow depending on the myocardial demand, and the phenomenon that we can call the "self-reparative ability," as published in this issue of the Journal. ⁷

It has previously been demonstrated that the ITA graft can grow in longitudinal length and transverse diameter in response to somatic growth of children with coronary obstruction. ⁸ This is the most clear-cut evidence to show that the ITA graft is a viable structure. Moreover, the ITA graft caliber at the anastomotic junction can also grow in children. ⁹ Probably the same mechanism can work on the stenotic anastomotic sites in adults, with resultant late reduction in the grade of anastomotic stenosis located between the . . . [Full Text of this Article]

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