Sachi Koyama1, Keiichi Itatani2, Tadashi Yamamoto3, Shohei Miyazaki4, Tadashi Kitamura5, Tuyoshi Taketani6, Minoru Ono7, Kagami Miyaji5. 1. Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan. 2. Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan Department of Hemodynamic Analysis, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan keiichiitatani@gmail.com. 3. Department of Cardiology, Hokkaido Cardiovascular Hospital, Hokkaido, Japan. 4. Department of Hemodynamic Analysis, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. 5. Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. 6. Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Chiyoda, Tokyo, Japan. 7. Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
Abstract
OBJECTIVES: Coronary artery bypass grafting for multivessel disease requires an appropriate graft design to avoid the competition of flow between the graft and the native vessel in order to achieve a sufficient coronary flow and durable graft patency. METHODS: Three-dimensional computational models of the left coronary artery were created based on the angiographic data. Three stenosis patterns of 75 and 90% combinations were created in the left anterior descending artery (LAD), the diagonal branch (Dx) and the circumflex artery (LCx). The left internal thoracic artery (LITA) was anastomosed to the LAD, and separate saphenous vein grafts (SVGs) were anastomosed to the Dx and the LCx in the 'Independent' model. The 'Sequential' model included sequential SVG anastomoses to the Dx and the LCx with a left internal thoracic artery-left anterior descending artery bypass, and Y-composite arterial grafts to LAD and Dx were created in the 'Composite' model. RESULTS: The 'Independent' model had high reverse flow from the Dx to the LAD in systole, resulting in decreased LITA flow when Dx stenosis was mild. The 'Sequential' model also had reverse flow in diastole, resulting in additional LAD flow. The 'Composite' model distributed increased flow to the Dx when Dx stenosis was severe, resulting in decreased flow to the LAD. CONCLUSIONS: Systematic flow evaluation is beneficial for determining the optimal bypass graft arrangement in patients with multivessel disease. Individual SVG anastomoses to the Dx and the LCx are not desirable when Dx stenosis is not severe and a Y-composite arterial graft to the LAD and the Dx is not desirable when Dx stenosis is severe.
OBJECTIVES: Coronary artery bypass grafting for multivessel disease requires an appropriate graft design to avoid the competition of flow between the graft and the native vessel in order to achieve a sufficient coronary flow and durable graft patency. METHODS: Three-dimensional computational models of the left coronary artery were created based on the angiographic data. Three stenosis patterns of 75 and 90% combinations were created in the left anterior descending artery (LAD), the diagonal branch (Dx) and the circumflex artery (LCx). The left internal thoracic artery (LITA) was anastomosed to the LAD, and separate saphenous vein grafts (SVGs) were anastomosed to the Dx and the LCx in the 'Independent' model. The 'Sequential' model included sequential SVG anastomoses to the Dx and the LCx with a left internal thoracic artery-left anterior descending artery bypass, and Y-composite arterial grafts to LAD and Dx were created in the 'Composite' model. RESULTS: The 'Independent' model had high reverse flow from the Dx to the LAD in systole, resulting in decreased LITA flow when Dx stenosis was mild. The 'Sequential' model also had reverse flow in diastole, resulting in additional LAD flow. The 'Composite' model distributed increased flow to the Dx when Dx stenosis was severe, resulting in decreased flow to the LAD. CONCLUSIONS: Systematic flow evaluation is beneficial for determining the optimal bypass graft arrangement in patients with multivessel disease. Individual SVG anastomoses to the Dx and the LCx are not desirable when Dx stenosis is not severe and a Y-composite arterial graft to the LAD and the Dx is not desirable when Dx stenosis is severe.