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Ann Thorac Surg 2006;82:620-623
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Sequential Bypass Grafting on the Beating Heart: Blood Flow Characteristics

Marek Gwozdziewicz, MD, PhD*, Petr Nemec, MD, PhD, Martin Simek, MD, Roman Hajek, MD, Martin Troubil, MD

Department of Cardiac Surgery, University Hospital, Olomouc, Czech Republic

Accepted for publication December 20, 2005.

* Address correspondence to Dr Gwozdziewicz, University Hospital Olomouc, I. P. Pavlova 6, Olomouc 775 15, Czech Republic (Email: gwozdziewicz{at}email.cz).

BACKGROUND: The sequential bypass technique is a routine method of myocardial revascularization. The aim of this study was to determine flow characteristics of individual and sequential bypass grafts created on the beating heart.

METHODS: Between January 2003 and February 2004, a consecutive series of 50 patients underwent off-pump coronary bypass surgery with at least one venous sequential coronary graft. During the procedure, flow values and pulsatility indexes were measured in both segments of the sequential graft using a CardioMed transit time flow meter (CM 4008; Medi-Stim, Oslo, Norway). The flow values were simultaneously compared with those of individual venous grafts sutured to the same coronary arteries.

RESULTS: The mean flow through the distal anastomosis (individual bypass; D1) was 37.4 mL/min, and this was not significantly influenced by the creation of a proximal sequential anastomosis (D2, 39.0 mL/min). In 32% of the patients, the sequential bypass was unwittingly connected proximally to a larger coronary bed; despite this, the flow in its distal segment was not less than that in the individual bypass.

CONCLUSIONS: The blood flow through an individual bypass is comparable with that through the distal segment (end-to-side anastomosis) of a sequential bypass. The grafting of a sequential bypass proximally to the larger artery (coronary bed) in sequence does not appear to have a significant effect on the blood flow in the distal segment of a sequential bypass.




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