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.
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.
Verhoye
Jean-Philippe
JP
Department of Thoracic and Cardiovascular Surgery, University Hospital Centre, Rennes, France.
Abouliatim
Issam
I
Drochon
Agnes
A
de Latour
Bertand
B
Leclercq
Christophe
C
Leguerrier
Alain
A
Corbineau
Hervé
H
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