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(Chest. 1994;106:1260-1263.)
© 1994 American College of Chest Physicians

Bilateral vs Single Internal Thoracic Artery Grafting for Left Main Coronary Artery Occlusion

Masaki Otaki MD1; Robert M. Lust PhD1; You Su Sun MD1; Terry O. Norton MD1; Paul A. Spence MD1; Richard S. Zeri MD1; Steven B. Hopson MD1; and W. Randolph Chitwood Jr MD, FCCP1

1 From the Department of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, NC.

This study was conducted to compare the coronary flow distributed by single and bilateral internal thoracic artery (ITA) grafts in the setting of the left main coronary occlusion. Ten dogs underwent coronary artery bypass grafting through a left thoracotomy, off pump, using a brief local occlusion to perform the anastomosis. Dogs were randomly assigned to receive either a single left ITA (LITA) graft to the circumflex coronary artery (CFX), or bilateral ITA grafts, with additional placement of the right ITA (RITA) to the left anterior descending artery (LAD). After the grafts were placed, the left main coronary artery was ligated. Electromagnetic flows were obtained in the LAD and the CFX proximally and distally to ITA grafts in both groups before grafting and after grafting. ITA flow in situ was also measured before rotation from the chest wall. Total left ventricular flow requirements were satisfied equally well by either a single LITA graft (116.7±11.6 mL/min) or bilateral ITA grafts (total, 116.8±9.6 mL/min divided as LITA, 55.9±7.4 mL/min; RITA, 60.9±12.0 mL/min). When two grafts were replaced, competitive flow in the proximal regions of both native vessels was noted, although basal flow requirements were maintained. When an individual graft was occluded in the bilaterally grafted system, the remaining graft immediately recruited the additional flow, demonstrating that either right or left ITA can support flow demands five to six times higher than in situ chest wall flow (RITA,21.9±3.1 mL/min; LITA, 22.3±4.9 mL/min). These data suggest that in this canine model, a single ITA graft can support the entire flow requirements of the left ventricle. Assuming no intervening stenosis is present in native coronary systems, bilateral ITA grafting may provide a margin of safety, but under resting conditions, provides no perfusion advantages over a single ITA graft.

Key Words: bilateral ITA grafts • competitive flow • left main coronary artery

Submitted on December 14, 1993
Accepted on May 11, 1994




This article has been cited by other articles:


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[Abstract] [Full Text] [PDF]


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