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Eur J Cardiothorac Surg 2007;31:49-54. doi:10.1016/j.ejcts.2006.09.033
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Collateral blood flow between left coronary artery bypass grafts and chronically occluded right coronary circulation in patients with triple vessel disease.

Observations during complete revascularisation of beating hearts

^a Department of Thoracic and Cardiovascular Surgery, University Hospital Centre, Rennes, France
^b School of Biotechnology, University of Compiegne, France
^c Department of Cardiology, University Hospital Centre, Rennes, France

Received 1 June 2006; received in revised form 6 September 2006; accepted 25 September 2006.

^_* Corresponding author. Address: Department de Chirurgie Thoracique et Cardiovasculaire, Centre Cardio Pneumologique, Hôpital Universitaire Pontchaillou, 35000 Rennes, France. Tel.: +33 299282490; fax: +33 299282496. (Email: jean-philippe.verhoye{at}chu-rennes.fr).

Objective: Preoperative measurements of collateral blood flow in patients with triple vessel disease and chronic occlusions of the right coronary artery do not, currently, ascertain the need to revascularise an occluded right coronary artery. We performed direct measurements of flow across left coronary bypass grafts to determine their contributions to collateral blood flow. Methods: Collateral blood flow was scored preoperatively according to Rentrop in 13 patients with triple vessel disease and chronic occlusions of the right coronary artery who underwent complete, off-pump, surgical revascularisation. The transit-time flow through the left coronary grafts was measured before and after unclamping of the right coronary artery bypass graft. Results: Unclamping of the right coronary artery bypass graft was associated with a 5.9 ± 6.9 ml/min (mean ± SD) decrease in flow across the left circumflex territory (P = 0.009), which was proportional to the preoperative Rentrop score (P = 0.007). No significant change was observed in flow across the graft to the left anterior descending artery. Conclusions: Grafts to the left circumflex system are the only grafts that supply a significant, albeit modest amount of collateral blood flow to chronically occluded right coronary artery. These observations confirm that (1) most collateral flow after revascularisation is supplied by the native network, and (2) revascularisation of an occluded right coronary artery is fully justified.

Key Words: Collateral blood flow • Coronary artery bypass graft • Off-pump heart surgery • Coronary pathophysiology

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				E. Apostolakis and K. Akinosoglou The coronary collaterals to the chronically occluded right coronary artery Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 685 - 686. [Full Text] [PDF]