title: Physiological and metabolic effects of grafts in coronary artery bypass surgery.
abstract: The internal thoracic artery (ITA) has become the gold standard graft material for modern coronary artery bypass grafting (CABG) because of its excellent long-term patency. The use of ITA grafts has also prolonged the postoperative survival of patients when applied to the left anterior descending artery or used bilaterally as 2 grafts for the left coronary system. Moreover, recent large-scale randomized clinical trials comparing the survival rates between CABG and percutaneous coronary intervention (PCI) with stents have shown that CABG is more effective for improving the survival of patients with severe coronary artery disease and/or in those with diabetes mellitus. The fundamental principle underlying these clinical benefits of CABG is the excellent endothelial function of the ITA, which provides physiological and metabolic effects that are beneficial not only for the graft itself, but also for the recipient coronary system. The production of nitric oxide and prostanoids by the ITA endothelium and their beneficial effects on the downstream coronary artery should therefore be taken into consideration when debating the merits of CABG vs. PCI.
authors.affiliation: National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. skitamur@hsp.ncvc.go.jp
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000818:Animals; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000378:metabolism / Q000601:surgery; D048909:Diabetes Complications / Q000378:metabolism / Q000601:surgery; D004730:Endothelium, Vascular / Q000378:metabolism*; D006801:Humans; D008323:Mammary Arteries / Q000378:metabolism* / Q000637:transplantation*; D009569:Nitric Oxide / Q000378:metabolism*; D011453:Prostaglandins / Q000378:metabolism*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D019737:Transplants
chemical_list: D011453:Prostaglandins; D009569:Nitric Oxide