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Ann Thorac Surg 2001;71:788-793
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Flow wire measurements after complete arterial coronary revascularization with T-grafts

^a Department of Cardiology, University Hospitals Homburg/Saar, Homburg/Saar, Germany
^b Department of Thoracic and Cardiovascular Surgery, University Hospitals Homburg/Saar, Homburg/Saar, Germany

Address reprint requests to Dr Markwirth, Medizinische Klinik III, Universitätskliniken des Saarlandes, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany
e-mail: t.markwirth{at}gmx.de

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.

Background. The T-graft procedure achieves complete arterial revascularization in coronary three-vessel disease. In this technique, all bypass anastomoses are supplied by the left internal mammary artery (IMA). This prospective study explores the question of whether the quantitative flow in such grafts is influenced by the pathology in the native coronary arteries.

Methods. Eighty-two patients with coronary three-vessel disease were studied after complete arterial coronary revascularization with T-grafts. Quantitative flow and coronary flow reserve were measured in the proximal IMA with a Doppler guide wire. Three groups were compared: group 1, all native coronary arteries were stenosed but patent (n = 31); group 2, one occluded native coronary vessel (n = 33); group 3, two or more occluded native coronary arteries (n = 18).

Results. Quantitative flow was significantly higher in group 3 than in group 2 at 1 week (93.9 ± 39.5 vs 75.8 ± 27.3 mL/min, p < 0.05) and 6 months postoperatively (86.0 ± 40.1 vs. 69.1 ± 35.5 mL/min, p < 0.05). Flow in group 2 was significantly (p < 0.05) higher than in group 1 (1 week: 58.0 ± 28.4 mL/min, 6 months: 55.2 ± 29.2 mL/min) in both examinations. There were no significant differences in coronary flow reserve between the three groups (1: 2.88 ± 0.97, 2: 2.84 ± 0.96, 3: 2.74 ± 0.94).

Conclusions. After complete arterial revascularization with T-grafts, the quantitative flow in the IMA is influenced by the status of the native coronary arteries. As a result of competitive flow phenomena, blood flow in the bypasses is significantly lower when the coronary arteries are affected only by stenosis.

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