title: Collateral blood flow between left coronary artery bypass grafts and chronically occluded right coronary circulation in patients with triple vessel disease. Observations during complete revascularisation of beating hearts.
abstract: OBJECTIVE
  Preoperative measurements of collateral blood flow in patients with triple vessel disease and chronic occlusions of the right coronary artery do not, currently, ascertain the need to revascularise an occluded right coronary artery. We performed direct measurements of flow across left coronary bypass grafts to determine their contributions to collateral blood flow.
  
  
  METHODS
  Collateral blood flow was scored preoperatively according to Rentrop in 13 patients with triple vessel disease and chronic occlusions of the right coronary artery who underwent complete, off-pump, surgical revascularisation. The transit-time flow through the left coronary grafts was measured before and after unclamping of the right coronary artery bypass graft.
  
  
  RESULTS
  Unclamping of the right coronary artery bypass graft was associated with a 5.9+/-6.9ml/min (mean+/-SD) decrease in flow across the left circumflex territory (P=0.009), which was proportional to the preoperative Rentrop score (P=0.007). No significant change was observed in flow across the graft to the left anterior descending artery.
  
  
  CONCLUSIONS
  Grafts to the left circumflex system are the only grafts that supply a significant, albeit modest amount of collateral blood flow to chronically occluded right coronary artery. These observations confirm that (1) most collateral flow after revascularisation is supplied by the native network, and (2) revascularisation of an occluded right coronary artery is fully justified.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Centre, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.forename: Issam
authors.initials: I
authors.lastname: Abouliatim
authors.forename: Agnes
authors.initials: A
authors.lastname: Drochon
authors.forename: Bertand
authors.initials: B
authors.lastname: de Latour
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.forename: Hervé
authors.initials: H
authors.lastname: Corbineau
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003097:Collateral Circulation; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011184:Postoperative Period; D013318:Stroke Volume; D016277:Ventricular Function, Left