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Eur J Cardiothorac Surg 2003;24:81-85
© 2003 Elsevier Science NL

Effects of heart rate on phasic Y-graft blood flow and flow reserve in patients with complete arterial myocardial revascularizaton: an intravascular Doppler catheter study

^a Division of Cardiovascular Surgery, ‘L. Sacco’ Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
^b Division of Cardiology, ‘L. Sacco’ Hospital, Via G.B. Grassi 74, 20157 Milan, Italy

Received 14 September 2002; received in revised form 21 February 2003; accepted 17 March 2003.

^* Corresponding author. Tel.: +39-02-3904-2333; fax: +39-02-3904-2652
e-mail: massimo.lemma{at}fastwebnet.it

Objective: It is not well established whether the blood flow of arterial composite Y-grafts can efficiently respond to the flow demand of the coronary system early postoperatively. The aim of this study was to evaluate if soon after the operation, arterial composite Y-grafts can increase blood flow in response to an increase in myocardial oxygen consumption (MVO₂). Methods: Twenty-seven patients who received complete arterial myocardial revascularization using the left internal thoracic artery (LITA) and the radial artery (RA) as composite Y-graft gave their consent to a pre-discharge coronary angiography and intravascular flow velocity measurements using a Doppler guide wire. Flow measurements were performed in the LITA main stem, the distal LITA and the RA, both at rest and during atrial pacing at the 85% of the patient age-predicted maximum. The heart rate–systolic blood pressure product was considered as an indirect index of MVO₂. Hyperemic flow was determined after injection of adenosine. The flow reserve (FR) was defined as the ratio of blood flow during maximal hyperemia (Q_max) to baseline flow (Q_basal). Results: Atrial pacing increased MVO₂ significantly (P<0.000). None of the patients developed ischemic S-T segment modifications or complained of chest pain. Q_basal increased significantly in the LITA main stem (P=0.001), distal LITA (P=0.041) and RA (P=0.004) while Q_max did not change significantly. As a consequence, the FR decreased in the LITA main stem (P=0.002), distal LITA (P<0.000) and RA (P<0.000) but was not completely exhausted. Conclusions: Soon after the operation, arterial composite Y-grafts can significantly increase blood flow in response to conditions of increased MVO₂, keeping normal the myocardial O₂ supply-to-demand ratio.

Key Words: Y-graft • Composite arterial graft • Left internal thoracic artery • Radial artery • Flow reserve • Atrial pacing

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