Impact of competitive blood flow from the venous graft to diagonal branch on ITA – LAD bypass graft failure

• Aslanbek V. Karaev
• Alan B. Gurdzibeev
• Sergey A. Donakanyan
• Lasha D. Shengelia
• Maria O. Konshina
• Karen V. Petrosian

Abstract

The aim of the study was to analyze the possibility of the development of competitive blood flow with subsequent of the internal thoracic artery (ITA) graft failure not only from the native coronary artery, but also from the formed venous graft to one system of the coronary artery internal thoracic artery to left anterior descending (ITA–LAD) bypass graft, venous graft to diagonal brunch.

Material and methods. Within the framework of the study conducted on the basis of the Bakulev National Scientific and Practical Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation in the period from January 2019 to December 2022, a group of patients with the failure of the ITA– LAD and the presence of a functioning venous shunt to the diagonal branch, which was the source of blood supply to LAD. The data of 11 patients who underwent CABG surgery under the control of intraoperative angiography were subjected to this retrospective analysis.

Results. The average time from coronary artery bypass graft (CABG) surgery to hospitalization was 34.1 months. The ejection fraction increased to 57±10.4%, however, no statistically significant differences were found relative to this parameter (p>0.05). There were no significant differences with respect to stenotic lesions of the pancreas before and after CABG surgery (p>0.05). All the subjects had occlusion of only one ITA – LAD bypass graft. The contrast of native breast cancer occurred retrograde with selective bypass grafting of the venous graft to the diagonal brunch.

Conclusion. Careful planning of the operation’s volume, a scientifically based approach to the choice of conduits and the competitive blood flow risks calculation can significantly increase its effectiveness in the long term, increasing the life of the grafts.

Keywords:internal thoracic artery bypass graft; competitive blood flow; ischemic heart disease; fractional flow reserve; instantaneous blood flow reserve

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