title: Should the supplemental vein graft be anastomosed upstream or downstream of the internal thoracic artery (ITA) for ITA hypoperfusion?
abstract: BACKGROUND
  This study was designed to compare internal thoracic artery (ITA) flow in different settings of supplemental vein grafting for ITA hypoperfusion.
  
  
  METHODS
  Fourteen dogs each received two coronary bypass grafts to the circumflex artery (CFX), using left ITA and vein grafts, and then the proximal CFX was ligated. The animals were divided into two groups. G-I dogs receiving the vein graft proximally to the ITA graft and G-II receiving the vein distally. ITA flow was evaluated regarding 1) effects of competition from the vein graft, and 2) pharmacological or physiological effects on the ITA's contribution to distal perfusion. Flow is expressed as a mean (ml/min).
  
  
  RESULTS
  ITA flow was 44.2+/-5.9 in G-I, and 45.7+/-6.5 in G-II (p=ns), when the vein graft was occluded. With a vein graft open, ITA flow decreased to 7.5+/-1.6 in G-I, and 6.8+/-1.8 in G-II (p=ns), and ITA's contribution to total perfusion requirements was 18% in G-I and 16% in G-II. Adenosine (0.2 mg/min/kg) increased the ITA flow in both groups, 18.4+/-3.2, and 16.3+/-3.8, respectively (p=ns), and ITA's contribution to distal perfusion was increased to 32% in G-I and 27% in G-II. In contrast, phenylephrine (0.003 mg/min/kg) decreased ITA flow and ITA's contribution to distal flow in both groups (6.1+/-1.1, 11% vs 6.2+/-1.4, 11%, p=ns), but increased vein flow significantly. Cardiac pacing (150 bpm) increased the ITA flow and ITA's contribution to distal perfusion equally in both groups (8.4+/-1.5, 16% vs 7.6+/-2.6, 15%, p=ns).
  
  
  CONCLUSIONS
  Supplemental vein grafting, whether it is placed distally or proximally, limits ITA flow and ITA's contribution to distal perfusion both in the resting heart and during the increased myocardial oxygen demand.
authors.affiliation: Department of Cardiovascular Surgery, Kinki University Hospital, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Otaki
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Oku
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001783:Blood Flow Velocity; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation; D004195:Disease Models, Animal; D004285:Dogs; D006083:Graft Occlusion, Vascular / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000503:physiopathology*; D010656:Phenylephrine; D013895:Thoracic Arteries / Q000502:physiology* / Q000637:transplantation
chemical_list: D010656:Phenylephrine