Flow dynamics and wall shear stress in the left internal thoracic artery: composite arterial graft versus single graft☆

Lemma, Massimo; Innorta, Andréa; Pettinari, Matteo; Mangini, Andrea; Gelpi, Guido; Piccaluga, Manuela; Danna, Paolo; Antona, Carlo

doi:10.1016/j.ejcts.2006.01.035

Cited by 19 publications

(9 citation statements)

References 13 publications

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“…

Through their recent article, Lemma et al [1] reported gratifying adaptability to the flow of proximal LIMA when using Y-graft revascularisation, corroborating previous investigation in this field [2], and on which the authors should be congratulated.Although the authors concluded that the distal flow of LIMA is similar between Y-graft and single graft groups, exclusive Ygraft revascularisation may raise concerns over attendant physiological disturbances afflicted to the integrated perfusion of coronary systems and their interplay. Apart from successfully measuring the relative flow and demonstrating technical feasibility, the exclusive T-or Y-graft nonetheless results in a perfusion pattern similar to a left-dominant coronary system.

It is well documented that the systolic antegrade flow of LAD is composed by antegrade flow from left Valsalva sinus and systolic retrograde given way by its collaterals such as septal and diagonal arteries [3].

…”

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confidence: 58%

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Y-graft and proximal LIMA flow adaptability: the surgical wisdom of iatrogenics

Kargar¹,

Aazami²

2006

European Journal of Cardio-Thoracic Surgery

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Through their recent article, Lemma et al. [1] reported gratifying adaptability to the flow of proximal LIMA when using Y-graft revascularisation, corroborating previous investigation in this field [2], and on which the authors should be congratulated.Although the authors concluded that the distal flow of LIMA is similar between Y-graft and single graft groups, exclusive Ygraft revascularisation may raise concerns over attendant physiological disturbances afflicted to the integrated perfusion of coronary systems and their interplay. Apart from successfully measuring the relative flow and demonstrating technical feasibility, the exclusive T-or Y-graft nonetheless results in a perfusion pattern similar to a left-dominant coronary system.It is well documented that the systolic antegrade flow of LAD is composed by antegrade flow from left Valsalva sinus and systolic retrograde given way by its collaterals such as septal and diagonal arteries [3]. Although being slighted in routine practice, the functional role of the latter is crucial. When occluding LAD with balloon, the amount of systolic recruitable collateral flow in LAD increases proportional to increasing flow in contralateral artery [4]. Such a collateral flow that is dependant on myocardium contractility [5], myocardial collateral pump, gives horizon to new integrated insights in coronary physiology, consequences of which should be taken surgically in good advantage.Therefore, LAD can be seen as having two potential inflows, double-LAD inflow, the importance of which is obvious in clinical practice, such as in the setting of occluded LAD and myocardial hypertrophy where the amount of systolic recruitable flow is increased. Similarly, the loss of contractility by septal infarction that blunt myocardial collateral pump could be an explanation to the poor outcome carried by.As an added level of complexity, one should integrate the coronary dominance with the above quoted considerations. A left-dominant coronary system should be though seen as providing the most amount of systolic LAD perfusion through a single system inflow, left coronary ostium; a pattern that can be deemed as singly double-LAD inflow while the right dominant or co-dominant coronary systems can potentially feed LAD by two separate inflow (right and left coronary ostia), doubly double-LAD inflow. A more potentially restrictive flow offered by singly double-LAD inflow compared with doubly double-LAD inflow pattern can, therefore, support the higher clinical incidence of angina in patients presenting with aortic stenosis, normal epicardial arteries, and left-dominant coronary system.Provided that surgical revascularisation results in resuming normal physiological coronary flow, coronary bypass grafting should be considered as an opportunity to offer patients to be provided with a doubly double-LAD inflow pattern, even in the case of patient's left-dominant coronary system, and not to transform routinely a native doubly double-LAD inflow into a potentially restrictive singly double-LAD inflow by ex...

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“…

…”

supporting

confidence: 58%

“…Through their recent article, Lemma et al [1] reported gratifying adaptability to the flow of proximal LIMA when using Y-graft revascularisation, corroborating previous investigation in this field [2], and on which the authors should be congratulated.…”

supporting

confidence: 58%

Y-graft and proximal LIMA flow adaptability: the surgical wisdom of iatrogenics

Kargar¹,

Aazami²

2006

European Journal of Cardio-Thoracic Surgery

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“…From the anesthetized in vivo hemodynamic measurements, carotid artery wall shear stress (WSS) was calculated as previously reported [25]:…”

Section: Methodsmentioning

confidence: 99%

Blood Pressure, Artery Size, and Artery Compliance Parallel Bone Size and Strength in Mice With Differing Ece1 Expression

Wang

Kristianto

Ooi

et al. 2013

Journal of Biomechanical Engineering

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The recombinant congenic mouse strains HcB-8 and HcB-23 differ in femoral shape, size, and strength, with HcB-8 femora being more gracile, more cylindrical, weaker, and having higher Young's modulus. In previous work, we mapped a robust, pleiotropic quantitative trait locus for these bone traits. Ece1, encoding endothelin converting enzyme 1, is a positional candidate gene for this locus, and was less expressed in HcB-8 bone. We hypothesized that the same genetic factors would impose analogous developmental trajectories on arteries to those in bones. Cardiovascular hemodynamics and biomechanics of carotids were measured in adult HcB-8 and HcB-23 mice. Biological differences in heart and arteries were examined at mRNA and protein levels. As in bone, Ece1 expression was higher in HcB-23 heart and arteries (p < 0.05), and its expression was correlated with that of the endothelin B type receptor target Nos3, encoding endothelial nitric oxide synthase. HcB-8 mice had higher ambulatory blood pressure (p < 0.005) than HcB-23 mice. Ex vivo, at identical pressures, HcB-8 carotid arteries had smaller diameters and lower compliance (p < 0.05), but the same elastic modulus compared to HcB-23 carotid arteries. HcB-8 hearts were heavier than HcB-23 hearts (p < 0.01). HcB-8 has both small, stiff bones and small, stiff arteries, lower expression of Ece1 and Nos3, associated in each case with less favorable function. These findings suggest that endothelin signaling could serve as a nexus for the convergence of skeletal and vascular modeling, providing a potential mechanism for the epidemiologic association between skeletal fragility and atherosclerosis.

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“…Apart from such peculiar conditions, detractors of the composite arterial grafting raised doubts about the flow adaptability of the left IMA when used as the only inflow for composite arterial grafting. Nevertheless, there is ample evidence from several studies published in the past decade [29][30][31][32][33] that the left internal thoracic artery (LITA) shows a marked adaptability to flow dynamics. In particular, an elegant study by Affleck and colleagues [30] identified a consistent flow reserve in the LIMA-radial composite grafting, as demonstrated by their intraoperative flow recordings for each limb of the T graft before and after distal anastomoses in 204 patients.…”

Section: Concerns and Controversiesmentioning

confidence: 99%

Y grafting for coronary artery bypass: is it as good as single grafting?

Bisleri

Muneretto

2009

Current Opinion in Cardiology

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Composite Y grafting with the exclusive use of arterial conduits is a well tolerated and effective technique. The choice of the second arterial conduit should be tailored according to the specific patients' characteristics. The association of composite arterial grafting and off-pump technique allows a no-touch technique of the ascending aorta, thereby also minimizing the risk of neurological events.

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Flow dynamics and wall shear stress in the left internal thoracic artery: composite arterial graft versus single graft☆

Cited by 19 publications

References 13 publications

Y-graft and proximal LIMA flow adaptability: the surgical wisdom of iatrogenics

Y-graft and proximal LIMA flow adaptability: the surgical wisdom of iatrogenics

Blood Pressure, Artery Size, and Artery Compliance Parallel Bone Size and Strength in Mice With Differing Ece1 Expression

Y grafting for coronary artery bypass: is it as good as single grafting?

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