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Eur J Cardiothorac Surg 2007;31:376-381. doi:10.1016/j.ejcts.2006.11.023
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Fractional flow reserve of pedicled internal thoracic artery and saphenous vein grafts 6 months after bypass surgery

^a University Hospital Saint-Luc, Department of Cardiovascular Medicine and Surgery, Brussels, Belgium
^b University Hospital Saint-Luc, Department of Internal Medicine, Brussels, Belgium
^c School of Public Health, Unit EPID of the Catholic University of Louvain Medical School, Brussels, Belgium

Received 28 September 2006; received in revised form 27 October 2006; accepted 16 November 2006.

^_* Corresponding author. Address: Service de Chirurgie cardiovasculaire et thoracique, Cliniques Universitaires Saint-Luc – U.C.L. 90, Avenue Hippocrate 10/6107, 1200 Bruxelles, Belgium. Tel.: +32 2 7646106; fax: +32 2 7648960. (Email: david.glineur{at}clin.ucl.ac.be).

Background: Although the internal thoracic artery was proven superior to saphenous vein graft in long-term patency, it is thought to be a more resistive conduit than the vein graft. Moreover, patency studies comparing both left and right internal thoracic arteries have provided results favoring the former. Fractional flow reserve is an established functional index of coronary blood flow. Methods: To compare the fractional flow reserve between both internal thoracic arteries and saphenous vein grafts, 43 bypass grafts were studied 6 months after revascularization. Intra-graft pressures were measured during cardiac catheterization using a pressure-wire advanced to the first distal anastomosis of 12 left internal thoracic arteries (ITAs), 10 right ITAs and of 21 vein grafts. Pressure gradients between the aorta and the graft were measured at baseline and during a maximal hyperemia. Results: At baseline, pressure gradient was recorded in the left ITA (2.9 ± 2.2 mmHg), in the right ITA (1.2 ± 1.2 mmHg) and in the vein graft (0.4 ± 0.7 mmHg). During maximal hyperemia, pressure gradient increased to 9.6 ± 3.2 mmHg in left ITA, to 4.5 ± 2.0 mmHg in the right ITA (p < 0.001 vs left ITA) and to 3.3 ± 2.7 mmHg in vein (p < 0.001 vs left ITA; NS vs right ITA). Fractional flow reserve was 0.90 ± 0.04 in left ITA, 0.95 ± 0.03 in right ITA (p < 0.01 vs left ITA) and 0.96 ± 0.03 in vein (p < 0.001 vs left ITA). Conclusion: Internal thoracic arteries and saphenous vein grafts allow myocardial revascularization with minimal resistance to maximal blood flow. The resistance appears significantly higher in left ITA compared to both the right ITA and venous grafts.

Abbreviations: FFR = fractional flow reserve • ITA = internal thoracic artery • LAD = left anterior descending coronary artery • SV = saphenous vein • LCX = left circumflex • RCA = right coronary artery

Key Words: Coronary artery bypass • Internal mammary artery • Saphenous vein graft • Fractional flow reserve

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