Does rich coronary collateral circulation distal to chronically occluded left anterior descending artery compete with graft flow?

Kaku, Daisuke; Nakahira, Atsushi; Hirai, Hidekazu; Sasaki, Yasuyuki; Hosono, Mitsuharu; Bito, Yasuyuki; Suehiro, Yasuo; Suehiro, Shigefumi

doi:10.1093/icvts/ivt337

Cited by 12 publications

(14 citation statements)

References 19 publications

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“…We believe that the term competitive flow in this context is limited and does not adequately describe the “resistance to forward flow” downstream from a patent graft. As we summarized in Figure , other factors that might contribute to resistance and forward flow are as follows: the degree of proximal stenosis, flow from other grafts to the area, flow from coronary collaterals (particularly in the setting of chronically occluded arteries), size and quality of the grafted vessel, filling pressures of the heart chambers, and mean arterial perfusion pressure …”

Section: Discussionmentioning

confidence: 99%

“…Graft failure is generally associated with the severity of the proximal stenosis, which in turn affects competitive flow from native vessels, other bypass grafts or collateral vessels, and the quality of the grafted vessel and tandem myocardium perfused by the grafted vessel . Differences between microvascular health and microvascular disease, as described by Gutterman et al may also play a fundamental role.…”

Section: Introductionmentioning

confidence: 99%

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Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

et al. 2019

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Introduction: Arterial graft physiology influences the long-term outcome of coronary artery bypass grafting (CABG). We studied factors that can affect the overall resistance to flow using internal mammary artery grafting to the left anterior descending artery.Methods: This was a prospective, nonrandomized observational study of 100 consecutive patients who underwent elective on-pump isolated or combined valve surgery and CABG. Coronary stenoses were assessed using conventional and quantitative coronary angiography assessment. The flow and pulsatility index (PI) of the grafts were assessed by transit-time flowmetry during cardioplegic arrest and at the end of the operation. Fractional polynomials were used to explore linearity, followed by multivariable regression analysis.Results: Univariate analysis demonstrated higher flows at the end of the operation in patients who had higher flows with the cross-clamp on (P < .001), in males (P = .004), in patients with a low PI at the end of the operation (P = .04), and in patients with a larger size of the recipient artery (P = .005). Multivariable regression analysis showed that the graft flow at the end of the operation was significantly associated with the mean flow with the cross-clamp on (P < .001), sex (P = .003), and PI at the end of the operation (P = .003). Concomitant valve surgery did not influence flows. Male patients had 18 mL/min higher flow. Conclusions:The graft flow at the end of the operation can be determined by the flow with the cross-clamp on, the PI with the cross-clamp off and coronary artery. We reported differences in the graft flows between sexes, and for first the time, we introduced the concepts of "adequate flow" and "resistance-to-forward-flow" for patent coronary grafts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

et al. 2019

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“…Few reports regarding fate and effect of collateral circulation after CABG exist. Kaku and coresearchers have shown that the presence of rich collateral circulation can reduce graft flow and increase the pulsatility index and that preoperative collateral vessels can disappear after ITA grafting [12]. Takami and colleagues reported that the disappearance of collateral vessels may depend on the anastomosis location of ITA to LAD [13].…”

Section: Discussionmentioning

confidence: 99%

Current mechanisms of low graft flow and conduit choice for the right coronary artery based on the severity of native coronary stenosis and myocardial flow demand

Nakajima

Takazawa

Yoshitake

et al. 2019

Gen Thorac Cardiovasc Surg

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Objectives We investigated current mechanisms causing low graft flow (LGF) following coronary artery bypass grafting, particularly for the right coronary artery (RCA). Methods We retrospectively assessed 230 individual bypass grafts as the sole bypass graft for the RCA using preoperative and postoperative quantitative angiography. Overall, 155 in-situ gastroepiploic arteries (GEAs) and 75 saphenous vein grafts (SVGs) were included. The size and status of the revascularised area were examined to determine whether these factors were associated with LGF (defined as ≤ 20 mL/min with intraoperative flowmetry). A distal lesion was defined as stenosis at segment #4, whereas a proximal lesion was stenosis at #1, #2 and #3. Results Graft flow in the SVG and the GEA for distal lesion was significantly less compared with that for proximal lesion (34 ± 26 vs. 60 ± 46, p < 0.0001 and 22 ± 12 vs. 43 ± 28, p = 0.0004, respectively). For proximal lesion, LGF was significantly more frequent when the minimal luminal diameter was over 1.27 compared with when it was less than 1.27 (p = 0.02). Prior myocardial infarction significantly correlated with LGF in the GEA (p = 0.007) and the SVG (p = 0.03). In 55 bypass grafts with LGF, the causes were competitive flow in 20.0%, small revascularised area in 38.1% and prior myocardial infarction in 32.7%. Conclusions Along with the current strategy based on the severity of native coronary stenosis, the incidence of competitive flow decreased remarkably. This resulted in flow demand, myocardial status and collateral vessels more influential on graft patency.

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“…As explained in Section II, Kaku et al [17] found that retrograde collateral perfusion tends to be surmounted by ITA graft flow and disappears over time, since collateral channels are supposedly much smaller, providing greater resistance to flow than the ITA graft. Furthermore, ITA graft flow can increase over time, as collateral perfusion declines, since the ITA can autoregulate its flow depending on the demand and resistance of distal myocardial territories.…”

Section: -Studies That Conclude That Collateral Flow Does Not Inflmentioning

confidence: 97%

“…There are few papers reaching this conclusion; globally, these argue that the underlying mechanism is related to flow competition. Kaku et al [17] investigated whether a well-developed collateral circulation distal to chronically occluded left anterior descending artery competes with the flow of a distally anastomosed graft. Their patients were divided into three groups: Poor collaterals, Group P (Rentrop grade 0 or 1); Moderate collaterals, Group M (Rentrop grade 2); Rich collaterals, Group R (Rentrop grade 3).…”

Section: -Studies That Conclude That Good Collateral Flow Has a Dementioning

confidence: 99%

Coronary Collaterals and Graft Failure

Drochon

Anselmi

Harmouche

et al. 2016

Coronary Graft Failure

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In this chapter, we recall the role of the coronary collateral circulation in severe obstructive coronary diseases, and, based on the literature review, we try to provide an answer to the question: when the patients undergo aorto-coronary bypass graft surgery, does good collateral flow reduce the risk of graft disease or, on the contrary, does it increase the risk of graft disease? In order to get additional arguments, a review of the numerical models and simulations addressing this problem is also included in the chapter.

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Does rich coronary collateral circulation distal to chronically occluded left anterior descending artery compete with graft flow?

Cited by 12 publications

References 19 publications

Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

Beyond patency: Functional assessment of adequacy using internal mammary artery grafting to the left anterior descending artery

Current mechanisms of low graft flow and conduit choice for the right coronary artery based on the severity of native coronary stenosis and myocardial flow demand

Coronary Collaterals and Graft Failure

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