Blood flow in composite arterial grafts and effect of native coronary flow

Background. Total arterial coronary revascularization can be achieved by joining arteries together as a composite graft with the proximal left internal mammary artery as the only source of blood inflow. Proof of the capacity of this composite conduit to provide adequate blood flow to the coronary circulation is required. Methods. The radial artery was anastomosed to the left internal mammary artery as a ygraft in 17 patients and all coronary arteries grafted. Intraoperative blood flow through the composite grafts was evaluated by the transit-time Doppler technique. Results. Against no resistance, blood flow in the left internal mammary artery alone was 99 ± 9 mL/min and rose to 173 ± 16 mL/min when the radial artery was anastomosed as a ygraft. Composite-graft flow following grafting was 88 ± 9 mL/min, 49 ± 6 mL/min when the aortic clamp was removed and native coronary flow restored and 82 ± 13 mL/min following weaning from cardiopulmonary bypass. The maximal potential flow through the composite graft was 2.3-fold (95% CI 1.6 to 3.2) greater than that after cardiopulmonary bypass. Conclusions. Total arterial revascularization, using a composite graft, provided a 2.3-fold reserve of blood flow to the coronary vascular bed through the grafts.