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Ann Thorac Surg 1999;67:644
© 1999 The Society of Thoracic Surgeons

Commentary

Hendrick B. Barner, MDa

a Division of Cardiothoracic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 3108 Queeny Tower, St. Louis, MO, USA 63110-1013

Invited commentary

The authors report additional experience with recycling of arterial conduits at coronary reoperations. Reoperations are usually associated with diseased vein grafts and progression of coronary arteriosclerosis. It is entirely logical to have the goal of replacing arteriosclerotic vein grafts with arterial conduits if this can be safely accomplished, and it can by those experienced with arterial conduits despite the increased complexity of using arterial conduits in the necessary configurations.

The success of the internal thoracic artery (ITA) T graft has provided support to the "recycling movement" by demonstrating that single-source inflow is physiologically effective despite concern by many that flow may be inadequate. My experience with the radial artery T graft in 650 primary operations is also confirmatory of a less than 1% incidence of hypoperfusion. However, it is well known that arterial conduit hypoperfusion may exist at a subclinical level in the first months after operation, but coronary flow reserve is restored to a normal level by 12 months or less through arterial remodeling.

In 93 patients from 1995 through 1998, who had reoperative coronary artery bypass grafting with use of at least one radial artery, there was recycling of arterial conduits in 18. In all, the previously used left ITA was recycled by creating a radial artery T graft, but other strategies, as described by the authors, were also used. Hypoperfusion was not recognized. I agree that an arterial conduit is an important commodity that should be maximally used to achieve replacement of diseased vein grafts with arteries. I applaud this report and the approach to reoperative coronary artery grafting that it espouses.


Related Article

Recycling of arterial grafts during reoperative coronary artery operations
Philippe H. Noirhomme, Malcolm J. Underwood, Gebrine A. El Khoury, David Glineur, Badwi Elias, Yves d’Udekem, and Robert A. Dion
Ann. Thorac. Surg. 1999 67: 641-644. [Abstract] [Full Text] [PDF]




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