title: Chronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: long-term angiographic results of 2 different revascularization strategies.
abstract: OBJECTIVE
  To compare 2 different surgical approaches to treatment of patients with isolated predivisional stenosis of the left main coronary artery (IOSLM) and to evaluate the effect of chronic competitive flow from a patent arterial or venous graft to the circumflex system on the long-term patency of internal thoracic artery (ITA) to left anterior descending grafts.
  
  
  METHODS
  Thirty-two patients with IOSLM were treated at our institutions during a 9-year period: 14 patients received double ITA grafts, whereas 18 underwent ITA graft plus saphenous vein (SV) bypass. All patients were reviewed clinically and angiographically at long-term follow-up.
  
  
  RESULTS
  No patient died during hospitalization. At a mean follow-up of 96±9 months 7 patients had died (6 from noncardiac causes) and 5 had experienced angina/ischemia recurrence, without differences between the 2 revascularization strategies. At control reangiography all ITA and SV grafts were found to be fully patent, without evidence of caliber reduction or string sign in the ITA.
  
  
  CONCLUSIONS
  In patients with IOSLM, long-term ITA to left anterior descending artery patency is not jeopardized by chronic flow competition from a concomitant arterial or venous graft to the circumflex system. Notably, the addition of a second ITA graft or of a SV to the first ITA does not lead to differences in long-term angiographic patency. Our results minimize the role of flow competition in this setting and should be kept in mind when choosing the appropriate graft configuration.
authors.affiliation: Department of Cardiovascular Sciences, Catholic University, Rome, Italy. Electronic address: mgaudino@tiscalinet.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.affiliation: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
authors.affiliation: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Farina
authors.affiliation: Department of Cardiology, Université Catholique de Louvain, Mont Godinne, Belgium.
authors.forename: Claude
authors.initials: C
authors.lastname: Hanet
authors.affiliation: Clinique Saint Luc de Bouge, Namur, Belgium.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Etienne
authors.affiliation: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Clinique Saint Luc de Bouge, Namur, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Glineur
mesh_terms: D000368:Aged; D001530:Belgium; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D007558:Italy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency