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.
Cite this paper
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.
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