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Ann Thorac Surg 2004;78:1290-1294
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Flow Dynamics of the Internal Thoracic and Radial Artery T-Graft

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

Accepted for publication March 2, 2004.

^* Address reprint requests to Dr Barner, Division of Cardiothoracic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 3108 Queeny Tower, St. Louis, MO 63110, USA
barnerh{at}msnotes.wustl.edu

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

BACKGROUND: Complex use of arterial conduits has resurrected concerns about the adequacy of conduit flow. The T-graft is the extreme example of this trend. Our purpose was to identify the limitation of single source inflow and to compare flow capacity with completion coronary flow.

METHODS: Between February 1999 and November 2001, 372 patients underwent total arterial revascularization with the T-graft alone. Intraoperative flows were recorded for each limb of the T-graft before and after distal anastomoses in 204 patients. Independent predictors of T-graft flow were identified by multivariate analysis.

RESULTS: Free flow for the radial arterial (RA) limb was 161 ± 81 mL/min, the internal thoracic artery (ITA) limb 137 ± 57 mL/min (combined 298 ± 101 mL/min) versus simultaneous limb flow of 226 ± 84 mL/min giving a flow restriction of 24% ± 14%. Completion coronary flow was 88 ± 49 mL/min for the RA, 60 ± 45 mL/min for the ITA, and 140 ± 70 mL/min for both limbs simultaneously to give a flow reserve (vs simultaneous free flow) of 160% or 1.6. Independent predictors of completion RA limb flow are RA proximal diameter (p = 0.005), number of anastomoses (p = 0.018), and target stenosis (p = 0.005).

CONCLUSIONS: A flow reserve of 1.6 compares favorably with an ITA flow reserve of 1.8 at 1-month postoperatively and 1.8 for both the ITA T-graft and the ITA/RA T-graft at 1-week postoperatively as reported by others. Proximal RA diameter and competitive coronary flow influence completion T-graft flow. These data quantitate the limitation of single source inflow of the T-graft configuration and support its continued use.

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