Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Free Flow in Internal Thoracic Artery and Internal Thoracic Artery-Radial Artery Composite Graft

속가슴동맥 편 및 속가슴동맥-노동맥 복합이식편의 자유혈류

  • 고광표 (원광대학교 흉부외과학교실) ;
  • 이미경 (원광대학교 흉부외과학교실) ;
  • 류대웅 (원광대학교 흉부외과학교실) ;
  • 이삼윤 (원광대학교 흉부외과학교실) ;
  • 최종범 (원광대학교 흉부외과학교실)
  • Published : 2004.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The Y-composite graft of internal thoracic artery and radial artery is commonly used in coronary bypass surgery. The aim of this study is to look for a way to raise the free flow of the internal thoracic graft and to see flow dynamics of the Y-graft. Material and Method: In 15 patients undergoing coronary bypass surgery, free flow of the in-situ internal thoracic artery graft was measured using two different papaverine application methods; extraluminal papaverine spray in 7 patients and intraluminal papaverine injection in 8. In 18 other patients for whom the Y-graft was used, total free flow and flow changes from the two ends were measured. Result: The free flow of the in-situ internal thoracic artery graft almost doubled with internal papaverine injection than with external papaverine spray $(47.7\pm9.6$ mL/min $vs.100.8\pm26.3$ mL/min, p<0.001). Total flow of the Y-composite graft was significantly more than either flow of the internal thoracic artery end or radial artery graft end $(173.3\pm45.3$ mL/min vs. $121.1\pm34.3$ mL/min or $117.5\pm42.8$ mL/min). When both ends of the Y-composite graft were opened, free flows from the two ends were similar $(85.4\pm27.8$ mL/min vs: $87.9\pm42.4$ mL/min, p=0.772). The flow of one end of the Y-composite graft was increased significantly by clamping of the other-end than when both ends were opened. Conclusion: Intraluminal papaverine injection is very effective in raising free flow of the internal thoracic artery graft, and the free flow of the Y-composite graft of in-situ internal thoracic artery and free radial artery graft is more than that of the in-situ internal thoracic artery graft. The flow of one end flow of the Y-graft may be altered by the flow change of the other end.

배경 및 목적: 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 관상동맥우회 술에 많이 이용된다. 이 연구의 목적은 속가슴동맥 편의 혈류를 증가시킬 수 있는 방법을 찾고 Y-복합이식편의 혈류역학을 알고자 함이다. 대상 및 방법: 관상동맥우회 술을 받은 15예에서 속가슴동맥 편을 두 가지 방법으로 처치하여 속가슴동맥 혈류량을 측정하였다. 7예에서는 혈관 외부에만 파파베린 액을 처치하였고 8예에서는 혈관 내로 파파베린 액을 주입하였다. 다른 18예에서는 속가슴동맥 편과 유리 노동맥 편으로 Y-복합이식편을 만들어 사용하였고 그 자유 혈류량과 두 분지의 혈류 변화를 조사하였다. 결과: 속가슴동맥 편의 혈관 내로 파파베린을 주사한 경우는 혈관외부에 파파베린을 처치한 경우보다 약 2배의 자유혈류량을 얻을 수 있었다(47.7$\pm$9.6 mL/min와 100.8$\pm$26.3 mL/min, p<0.001). Y-복합이식편의 양측을 다 연 상태에서 총 자유혈류량은 속가슴동맥 측만을 열었을 때나 노동맥 측만을 열었을 경우보다 훨씬 많았다(173.3$\pm$45.3 mL/min와 121.1$\pm$34.3 mL/min 혹은 117.5$\pm$42.8 mL/min, 각각 p<0.001). Y-복합이식편의 양 분지를 다 연 경우 양측의 혈류량은 차이가 없었다(85.4$\pm$27.8 mL/min와 87.9$\pm$42.4 mL/min, p=0.772). Y-복합이식편에서 한 측의 혈류량은 다른 측을 열 때보다 막을 때 훨씬 많았다. 결론: 속가슴동맥 편의 혈관 내에 파파베린 액을 주입하는 방법은 자유혈류량을 올릴 수 있는 매우 효과적인 방법이다. 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 속가슴동맥의 단독이식편보다 더 많은 자유혈류량을 보이며, Y-복합이식편의 한 측의 혈류량은 다른 측의 혈류량의 변화에 따라 변할 수 있다.

Keywords

References

  1. Grondin CM, Campeau L, Lesperance J, Enjalbert M, Bourassa MG. Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation 1984;70:I208-12.
  2. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1986;314:1-6. https://doi.org/10.1056/NEJM198601023140101
  3. Lytle BW, McElroy D, McCarthy P, et al. Influence of arterial coronary bypass grafts on the mortality in coronary reoperations. J Thorac Cardiovasc Surg 1994;107:675-82.
  4. Royse AG, Royse CF, Raman JS. Exclusive Y graft operation for multivessel coronary revascularization. Ann Thorac Surg 1999;68:1612-8. https://doi.org/10.1016/S0003-4975(99)00676-1
  5. Royse AG, Royse CF, Groves KL, Bus B, Yu G. Blood flow in composite arterial grafts and effect of native coronary flow. Ann Thorac Surg 1999;68:1619-22. https://doi.org/10.1016/S0003-4975(99)00862-0
  6. Markwirth T, Hennen B, Scheller B, Schafers HJ, Wendler O. Flow wire measurements after complete arterial coronary revascularization with T-grafts. Ann Thorac Surg 2001;71: 788-93. https://doi.org/10.1016/S0003-4975(00)01808-7
  7. Choi JB, Lee SY. Skeletonized and pedicled internal thoracic artery grafts: effect on free flow during bypass. Ann Thorac Surg 1996;61:909-13. https://doi.org/10.1016/0003-4975(95)01171-4
  8. Dregelid E, Heldal K, Resch F, Stangeland L, Breivik K, Svendsen E. Dilation of the internal mammary artery by external and intraluminal papaverine application. J Thorac Cardiovasc Surg 1995;110:697-703. https://doi.org/10.1016/S0022-5223(95)70101-X
  9. Mills NL, Bringaze WLIII. Preparation of the internal mammary artery graft. Which is the best method? J Thorac Cardiovasc Surg 1989;98:73-7.
  10. Wendler O, Tscholl D, Huang Q, Schafers HJ. Free flow capacity of skeletonized versus pedicled internal thoracic artery grafts in coronary artery bypass grafts. Eur J Cardiothorac Surg 1999;15:247-50. https://doi.org/10.1016/S1010-7940(99)00012-3
  11. Speziale G, Ruvolo G, Coppola R, Marino B. Intraoperative flow measurement in composite Y arterial grafts. Eur J Cardiothorac Surg 2000;17:505-8. https://doi.org/10.1016/S1010-7940(00)00395-X
  12. Calafiore AM, Di Giammarco G, Luciani N, Maddestra N, Di Nardo E, Angelini R. Composite arterial conduits for a wider arterial myocardial revascularization. Ann Thorac Surg 1994;58:185-90. https://doi.org/10.1016/0003-4975(94)91097-9
  13. Weinschelbaum EE, Gabe ED, Macchia A, Smimmo R, Suarez LD. Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg 1997;114:911-6 https://doi.org/10.1016/S0022-5223(97)70004-7
  14. Chocron S, Etievent JP, Schiele F, et al. The Y graft: myocardial revascularization with both internal thoracic arteries. Evaluation of eighty cases with coronary angiographic assessment. J Thorac Cardiovasc Surg 1994;108: 736-40.
  15. Sakaguchi G, Tadamura E, Ohnaka M, Tambara K, Nishimura K, Komeda M. Composite arterial Y graft has less coronary flow reserve than independent grafts. Ann Thorac Surg 2002;74:493-6 https://doi.org/10.1016/S0003-4975(02)03729-3
  16. Jones EL, Lattouf OM, Weintraub WS. Catastrophic consequences of internal mammary artery hypoperfusion. J Thorac Cardiovasc Surg 1989;98:902-7.