In vivo comparison of free coronary grafts using the inferior epigastric (IEA), the gastroepiploic (GEA) and the internal thoracic artery (ITA).
The validity of alternative arterial conduits for myocardial revascularization in comparison to internal thoracic artery (ITA) has not been sufficiently defined. Evaluation of the functional in vivo vascular properties of the different conduits may be appropriate to give a perspective on long-term graft qualities. The intraoperative function of single free grafts to the left anterior descending artery (LAD) was compared in inferior epigastric (IEA, n = 13), internal thoracic (ITA, n = 12) and gastroepiploic artery (GEA, n = 12) conduits. Graft flows were measured at four points of time, 1) in situ free flow after distal dissection (IEA: 42.2 ml/min, ITA: 68.8 ml/min, GEA: 61.1 ml/min), 2) free flow following proximal grafting to the aorta (IEA: 48.1 ml/min, ITA: 63.7 ml/min, GEA: 84.2 ml/min), 3) selective graft flow after distal attachment to the LAD (IEA: 52.6 ml/min, ITA: 77.5 ml/min, GEA: 102.8 ml/min), and 4) selective LAD graft flow following paraverine (Pap) stimulation (IEA: 98.4 ml/min, ITA: 128.0 ml/min, GEA: 142.9 ml/min). Endothelium-dependent and -independent relaxation was evaluated by examination of the intraluminal graft pressures at mechanically controlled constant flow rates. Following stimulation with substance P (SP), the change of intraluminal pressure (dp) was similar in IEA (dp: -20.0 mmHg) and GEA grafts (dp: -21.1 mmHg). Only ITA conduits were less reactive to SP (-9.7 mmHg). The response to acetylcholine (ACh) could only be assessed in ITA (dp: -16.0 mmHg) and IEA (dp: -10.7 mmHg) grafts. Gastroepiploic arteries did not react on ACh stimulation (dp: +0.4 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)
Cremer
J
J
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Liesmann
T
T
Wimmer-Greinecker
G
G
Abraham
C
C
Mügge
A
A
Haverich
A
A
D000009:Abdominal Muscles / Q000098:blood supply*; D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D001158:Arteries / Q000502:physiology / Q000637:transplantation; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D010208:Papaverine / Q000494:pharmacology; D011183:Postoperative Complications; D012039:Regional Blood Flow / Q000187:drug effects; D013895:Thoracic Arteries / Q000502:physiology / Q000637:transplantation*; D014654:Vascular Patency / Q000187:drug effects
D010208:Papaverine; D000109:Acetylcholine