Preparation of the Internal Mammary Artery Graft in Coronary Artery Bypass Surgery - Comparison of Free Mammary Artery Flows -

관상동맥 우회로술에서 내유동맥 이식편의 처치방법에 따른 문합전 내유동맥 혈류량의 비교

To compare two methods of mammary pedicle graft preparations with free internal mammary artery flow, we studied 31 patients who had the left internal mammary artery harvested for coronary artery bypass grafting. The free flow was measured at the transected opening of 2 to 3 cm distal to the point of bifurcation on mean arterial pressure of 50 to 55 mmHg during cardiopulmonary bypass. Group I comprised 14 patients, whose grafts were sprayed and wrapped in sponges soaked in diluted papaverine solution (60 mg in 40 ml Hartmann's solution). An average 80 minutes after the preparations, free flow of the internal mammary artery ranged from 20 to 80 ml/min (mean 37.7 ml/min). Group II comprised 17 patients, who had internal mammary artery takedown under the exact conditions used in group I. The grafts were sprayed and wrapped in sponges soaked in the diluted papaverine solution as in group I. After an average of 28 minutes, free flow ranged from 8 to 28 ml/min (mean 17.6 ml/min). Intraluminal papaverine of the same dilution was then injected without any hydrostatic dilatation and flows increased upto 37 to 150 ml/min (mean 74.7 ml/min). This study shows that intraluminal papaverine preparation method markedly increases free mammary artery flow which is inadequate with external papaverine preparation.