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Otto M Hess - One of the best experts on this subject based on the ideXlab platform.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of thoracic and cardiovascular surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:Objective Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. Methods Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. Results Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 ± 8 vs 58 ± 29 mL/min, P P Conclusions Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
Beat H. Walpoth - One of the best experts on this subject based on the ideXlab platform.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of thoracic and cardiovascular surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:Objective Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. Methods Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. Results Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 ± 8 vs 58 ± 29 mL/min, P P Conclusions Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
H Gülker - One of the best experts on this subject based on the ideXlab platform.
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Angioplasty of the internal thoracic Artery bypass-Graft an alternative to reoperation.
International Journal of Cardiology, 2004Co-Authors: Roger Marx, Rolf-michael Klein, Thomas Ketteler, Christiana Mira Schannwell, Harald Lapp, Marc Horlitz, H GülkerAbstract:Abstract Background : This review presents an overview of interventional revascularization procedures of the internal thoracic Artery after prior implantation as a coronary-Artery bypass Graft. Methods : Our search was concentrated on the MEDLINE-database to identify all articles on internal thoracic Artery-Graft–angioplasties and reoperation after internal thoracic Artery bypass Grafting published between 1968 and 2000. Results : Surgical revascularization and reoperation were reported in five papers including a total of 785 patients. The overall mortality of these patients was 4.2%. The presence of a patent internal thoracic Artery-Graft at the time of reoperation was not a risk factor for higher morbidity and mortality. Revascularization with percutaneous transluminal coronary angioplasty of the internal thoracic Artery or the native left anterior descending Artery via the internal thoracic Artery-Graft used as a conduit was performed in 327 patients. The primary success rate was 87%, the angiographically assessed rate of restenosis was 30% and the rate of complications approximately 1%. Conclusions : Inspite of technical problems the percutaneous transluminal coronary angioplasty in or via internal thoracic Artery-Graft presents a safe and feasible option to be recognized before a potential reoperation.
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Angioplasty of the internal thoracic Artery bypass-Graft an alternative to reoperation.
International Journal of Cardiology, 2004Co-Authors: Roger Marx, Rolf-michael Klein, Thomas Ketteler, Christiana Mira Schannwell, Harald Lapp, Marc Horlitz, H GülkerAbstract:Abstract Background : This review presents an overview of interventional revascularization procedures of the internal thoracic Artery after prior implantation as a coronary-Artery bypass Graft. Methods : Our search was concentrated on the MEDLINE-database to identify all articles on internal thoracic Artery-Graft–angioplasties and reoperation after internal thoracic Artery bypass Grafting published between 1968 and 2000. Results : Surgical revascularization and reoperation were reported in five papers including a total of 785 patients. The overall mortality of these patients was 4.2%. The presence of a patent internal thoracic Artery-Graft at the time of reoperation was not a risk factor for higher morbidity and mortality. Revascularization with percutaneous transluminal coronary angioplasty of the internal thoracic Artery or the native left anterior descending Artery via the internal thoracic Artery-Graft used as a conduit was performed in 327 patients. The primary success rate was 87%, the angiographically assessed rate of restenosis was 30% and the rate of complications approximately 1%. Conclusions : Inspite of technical problems the percutaneous transluminal coronary angioplasty in or via internal thoracic Artery-Graft presents a safe and feasible option to be recognized before a potential reoperation.
Thierry Carrel - One of the best experts on this subject based on the ideXlab platform.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of thoracic and cardiovascular surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:Objective Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. Methods Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. Results Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 ± 8 vs 58 ± 29 mL/min, P P Conclusions Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
Friedrich S. Eckstein - One of the best experts on this subject based on the ideXlab platform.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:OBJECTIVE: Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. METHODS: Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. RESULTS: Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 +/- 8 vs 58 +/- 29 mL/min, P < .01). Postoperatively, internal thoracic Artery Graft flow increased significantly to 42 +/- 24 mL/min at 3 months and to 56 +/- 30 mL/min (P < .02 vs intraoperative value) at 10 months, respectively. However, saphenous vein Graft flow remained unchanged over time (58 +/- 29 to 50 +/- 27 mL/min at 3 months and 46 +/- 27 mL/min at 10 months). Coronary flow reserve was abnormally low intraoperatively in the internal thoracic Artery (1.3 +/- 0.3) and saphenous vein (1.6 +/- 0.5) Grafts but increased significantly to normal values in both types of Graft at follow-up. CONCLUSIONS: Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
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Vascular adaptation of the internal thoracic Artery Graft early and late after bypass surgery.
The Journal of thoracic and cardiovascular surgery, 2008Co-Authors: Beat H. Walpoth, Andreas Bosshard, Friedrich S. Eckstein, Thierry Carrel, Anna Schwab, Markus Schmid, Otto M HessAbstract:Objective Flow mismatch between the supplying Artery and the myocardial perfusion region has been observed in patients with internal thoracic Artery Grafts. Thus coronary flow changes of arterial (internal thoracic Artery Grafts) and saphenous (saphenous vein Grafts) bypass Grafts were studied early and late after coronary Artery bypass Grafting. Methods Thirty patients undergoing elective bypass surgery (internal thoracic Artery and saphenous vein Grafts) were studied intraoperatively and (17 patients) 3 to 10 months postoperatively. Coronary flow was measured intraoperatively with the transit-time Doppler scanning technique. Postoperatively, flow velocity and coronary flow reserve were determined with the Doppler flow wire technique. Quantitative angiographic analysis was used to determine vessel size for calculation of absolute flow. Results Intraoperatively, internal thoracic Artery Graft flow was significantly lower than saphenous vein Graft flow (31 ± 8 vs 58 ± 29 mL/min, P P Conclusions Bypass flow of the internal thoracic Artery Graft is significantly reduced intraoperatively when compared with that of the saphenous vein Graft. However, 3 and 10 months after the operation, flow of the internal thoracic Artery Graft increases significantly and is similar to saphenous vein Graft flow. This finding can be explained by an early flow mismatch of the native internal thoracic Artery in the presence of a large perfusion territory. During follow-up, there is vascular remodeling of the internal thoracic Artery, probably because of endothelium-mediated mechanisms.
