Changes in the Arterial Graft Flow Pattern after Intermittent Occlusion of the Anterior Descending Coronary Artery during Off-Pump Coronary Surgery in the Porcine Model
Background: During off-pump coronary surgery, temporary occlusion of the left anterior descending coronary artery (LAD) is often necessary as a preconditioning method or during the performance of the anastomosis. Our aim is to describe the effect of prolonged and intermittent occlusion of the LAD on the measurement of mean graft flow (MGF) and arterial graft pulsatility index (PI). Methods: Off-pump coronary surgery (internal mammary artery in situ to LAD) was performed on 8 pigs of the Landrace genotype. Tourniquets were placed proximal and distal to the site of the anastomosis. Intraoperative flow measurements were performed by the transit time method in the following phases: the baseline, during distal snaring of LAD, proximal snaring, and distal and proximal snaring at the same time; subsequently on up to 5 occasions, we repeated this proximal/distal occlusion for 5 minutes and measured the graft flow after its proximal and distal release. Results: During distal occlusion and simultaneously proximal and distal occlusion, the MGF decreased, and the PI increased (P < 0.05). After intermittent proximal/distal occlusion of the LAD and its subsequent release, the MGF progressively decreased, and the PI increased to become significant from the 3rd release (P < 0.05) compared with the baseline measurement. Within 10 minutes of the fifth release, the flow pattern normalised. Conclusion: Intermittent and/or prolonged proximal/distal occlusion of LAD may temporarily alter the flow pattern of the graft (decreased MGF and increased PI) once released. Temporary arterial vasospasm in coronary arteries with little atherosclerosis may be the explanatory cause of this phenomenon.
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Martínez-Comendador, J. M. , Estévez-Cid, F. , González-Barbeito, M. , Díaz-Allegue, M. , López, P. , Pérez, C. , Castillo, J. C. and Centeno, A. (2022). Changes in the Arterial Graft Flow Pattern after Intermittent Occlusion of the Anterior Descending Coronary Artery during Off-Pump Coronary Surgery in the Porcine Model. Open Access Library Journal, 9, e9385. doi: http://dx.doi.org/10.4236/oalib.1109385.
De Palo, M., Quagliara, T., Dachille, A., Carrozzo, A., Giardinelli, F., Mureddu, S., et al. (2019) Trials Comparing Percutaneous and Surgical Myocardial Revascularization: A Review. Reviews on Recent Clinical Trials, 14, 95-105.
https://doi.org/10.2174/1574887114666190201102353
Takagi, H., Ando, T. and Mitta, S. (2017) Meta-Analysis Comparing ≥ 10-Year Mortality of Off-Pump versus On-Pump Coronary Artery Bypass Grafting. The American Journal of Cardiology, 120, 1933-1938.
https://doi.org/10.1016/j.amjcard.2017.08.007
Kawajiri, H., Yaku, H., Glineur, D. and Ruel, M. (2017) Clampless versus Clamped Coronary Bypass Grafting: Does It Make a Difference? Current Opinion in Cardiology, 32, 737-743. https://doi.org/10.1097/HCO.0000000000000451
Loop, F.D., Lytle, B.W., Cosgrove, D.M., Stewart, R.W., Goormastic, M., Williams, G.W., et al. (1986) Influence of the Internal-Mammary-Artery Graft on 10-Year Survival and Other Cardiac Events. The New England Journal of Medicine, 314, 1-6. https://doi.org/10.1056/NEJM198601023140101
Sousa-Uva, M., Neumann, F.J., Ahlsson, A., Alfonso, F., Banning, A.P., Benedetto, U., et al. (2019) 2018 ESC/EACTS Guidelines on Myocardial Revascularization. European Journal of Cardio-Thoracic Surgery, 55, 4-90.
https://doi.org/10.1093/ejcts/ezy289
Niclauss, L. (2017) Techniques and Standards in Intraoperative Graft Verification by Transit Time Flow Measurement after Coronary Artery Bypass Graft Surgery: A Critical Review. European Journal of Cardio-Thoracic Surgery, 51, 26-33.
https://doi.org/10.1093/ejcts/ezw203
Thuijs, D.J.F.M., Bekker, M.W.A., Taggart, D., Kappetein, A.P., Kieser, T.M., Wendt, D., et al. (2019) Improving Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis on the Impact of Adopting Transit-Time Flow Measurement. European Journal of Cardio-Thoracic Surgery, 56, 654-663.
https://doi.org/10.1093/ejcts/ezz075
Di Giammarco, G., Pano, M., Cirmeni, S., Pelini, P., Vitolla, G. and Di Mauro, M. (2006) Predictive Value of Intraoperative Transit-Time Flow Measurement for Short-Term Graft Patency in Coronary Surgery. The Journal of Thoracic and Cardiovascular Surgery, 132, 468-474. https://doi.org/10.1016/j.jtcvs.2006.02.014
Leong, D.K., Ashok, V., Nishkantha, A., Shan, Y.H. and Sim, E.K. (2005) Trans-it-Time Flow Measurement Is Essential in Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery, 79, 854-857.
https://doi.org/10.1016/j.athoracsur.2004.06.010
Nordgaard, H., Nordhaug, D., Kirkeby-Garstad, I., Løvstakken, L., Vitale, N. and Haaverstad, R. (2009) Different Graft Flow Patterns Due to Competitive Flow or Stenosis in the Coronary Anastomosis Assessed by Transit-Time Flowmetry in a Porcine Model. European Journal of Cardio-Thoracic Surgery, 36, 137-142.
https://doi.org/10.1016/j.ejcts.2009.02.036
Torstensson, G.N., Torp, T.L., Rasuli-Oskuii, N. and Kjeldsen, B.J. (2013) Graft Flow Unaffected by Full Occlusion of Left Anterior Descending Artery during Coronary Artery Bypass Grafting in a Porcine Model. The Heart Surgery Forum, 16, E107-E113. https://doi.org/10.1532/HSF98.20121112
Sabik, J.F. and Blackstone, E.H. (2008) Coronary Artery Bypass Graft Patency and Competitive Flow. JACC: Journal of the American College of Cardiology, 51, 126-128.
https://doi.org/10.1016/j.jacc.2007.09.029
Gaudino, M., Alessandrini, F., Nasso, G., Bruno, P., Manzoli, A. and Possati, G. (2002) Severity of Coronary Artery Stenosis at Preoperative Angiography and Midterm Mammary Graft Status. The Annals of Thoracic Surgery, 74, 119-121.
https://doi.org/10.1016/S0003-4975(02)03614-7
Hangler, H.B., Pfaller, K., Antretter, H., Dapunt, O.E. and Bonatti, J.O. (2001) Coronary Endothelial Injury after Local Occlusion on the Human Beating Heart. The Annals of Thoracic Surgery, 71, 122-127.
https://doi.org/10.1016/S0003-4975(00)02181-0
Perrault, L.P., Menasché, P., Bidouard, J.P., Jacquemin, C., Villeneuve, N., Vilaine, J.P., et al. (1997) Snaring of the Target Vessel in Less Invasive Bypass Operations Does Not Cause Endothelial Dysfunction. The Annals of Thoracic Surgery, 63, 751-755. https://doi.org/10.1016/S0003-4975(96)01118-6
Yasue, H., Mizuno, Y. and Harada, E. (2019) Coronary Artery Spasm—Clinical Features, Pathogenesis and Treatment. Proceedings of the Japan Academy, Ser. B, Physical and Biological Sciences, 95, 53-66. https://doi.org/10.2183/pjab.95.005
Lorusso, R., Crudeli, E., Lucà, F., De Cicco, G., Vizzardi, E., D’Aloia, A., et al. (2012) Refractory Spasm of Coronary Arteries and Grafted Conduits after Isolated Coronary Artery Bypass Surgery. The Annals of Thoracic Surgery, 93, 545-551.
https://doi.org/10.1016/j.athoracsur.2011.09.078