Ann Thorac Surg 2003;76:64-65
© 2003 The Society of Thoracic Surgeons
Original article: cardiovascular
Invited commentary
Guo-Wei He, MD, PhDa
a Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098 USA
For a long time our research laboratory has investigated the mechanical properties of human arteries used as coronary artery bypass grafts in comparison to the coronary artery itself. We have long realized that the mechanical properties of arteries are different, as shown by our mechanical studies of the length-tension curve of these arteries. The differences are related to a number of anatomic, physiologic, and pharmacological factors. It is well established that arteries used as coronary grafts have different anatomic structures. One of the most obvious differences is that some arteries contain more smooth muscle cells and are therefore less elastic than coronary arteries. Examples include the gastroepiploic artery, inferior epigastric artery, and radial artery. In contrast, the internal mammary artery (IMA) contains more elastic laminae and may be more elastic [1]. Based on experimental studies of vasoreactivity, and together with physiological and embryological considerations, a functional classification for arterial grafts was proposed [2]. This classification suggests that there are three types of arterial grafts. Type I is composed of somatic arteries; type II, splanchnic arteries; and type III, limb arteries. Type II and III arteries are prone to spasm because of higher contractility and therefore require more active pharmacological intervention [2, 3].
The study by Van Andel and colleagues investigates mechanical properties of porcine and human coronary and internal mammary arteries. Although it was designed for clinical use in automatic anastomotic connectors, the study provides evidence that the mechanical properties, particularly elasticity, are different between porcine and human vessels. This is the major conclusion of the authors. However, this study supports another conclusion that is important if not more important: the human coronary artery and internal mammary artery have different elasticity, as shown in Figure 5. This figure adds further support for our classification of arterial grafts. Van Andel’s study stimulates more investigation of differences in mechanical properties among human arteries.
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- He G.-W., Yang C.-Q. Comparison among arterial grafts and coronary artery. An attempt at functional classification. J Thorac Cardiovasc Surg 1995;109:707-715.[Abstract/Free Full Text]
- He G.-W. Arterial grafts for coronary artery bypass: biological characteristics, functional classification, and clinical choice. Ann Thorac Surg 1999;67:277-284.[Abstract/Free Full Text]
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