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• W4247346044 abstract "We congratulate Gaudino and colleagues1Gaudino M. Alessandrini F. Pragliola C. Luciani N. Trani C. Burzotta F et al.Composite Y internal thoracic artery–saphenous vein grafts short-term angiographic results and vasoreactive profile.J Thorac Cardiovasc Surg. 2004; 127: 1139-1144Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholarfor the splendid idea advanced in their study on composite Y internal thoracic artery (ITA)–saphenous vein (SV) grafts. The study of the lumen contributes enormously to the current series of studies describing the characteristics of composite grafts. However, we do not share some of the opinions presented in this article. We believe that it is not right to use the term “flow steal” in this specific case, because the circulatory system is pressurized, is closed, and responds well to demand. We do not agree that SV grafts are the worst conduits. It is already known that SVs in aorta–left anterior descending coronary artery grafts are patent in 70% to 80% of the patients after 10 years. We also believe that the reduced diameter in distal ITA used to revascularize coronary arteries that have a proximal moderate stenosis (<70%) is physiologic and expected. The distal ITA lumen may be reduced as well when the supplied coronary artery has a poor runoff. If there is no flow demand, the ITA graft will decrease in caliber, because ITA has a huge ability to adapt itself to flow demand. It is commonly seen that an ITA supplying coronaries with proximal severe stenosis and a good runoff is usually dilated.2Ochi M. Hatori N. Bessho R. Fujii M. Saji Y. Tanaka S et al.Adequacy of flow capacity of bilateral internal thoracic artery T graft.Ann Thorac Surg. 2001; 72: 2008-2012Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar The fact that SV is less reactive does not compromise the coronary irrigation to which it is anastomosed, because the blood flow in SV is proportional to the coronary runoff and not to its diameter. Nevertheless, we agree with current studies that demonstrate ITA's capacity to adapt to flow demand.3Lobo Filho J.G. Leitão M.C. Lobo Filho H.G. Silva A.A. Machado J.J. Forte A.J et al.Myocardial revascularization surgery using composite Y-graft of the left internal thoracic artery blood flow analysis.Rev Bras Cir Cardiovasc. 2004; 19: 1-8Crossref Google Scholar We strongly believe that SV segments do not jeopardize the composite graft efficiency and have several advantages when used in such configuration: they are smaller, they suffer less pressure and shear stress, and they receive substances produced by ITA's endothelium (nitrous oxide, for example). These advantages are believed to increase SV graft durability.4Cox J.L. Chiasson D.A. Gotlieb A.I. Stranger in a strange land the pathogenesis of saphenous vein graft stenosis with emphasis on structural and functional differences between veins and arteries.Prog Cardiovasc Dis. 1991; 34: 45-68Abstract Full Text PDF PubMed Scopus (307) Google Scholar, 5Nwasokwa O.N. Coronary artery bypass graft disease.Ann Intern Med. 1995; 123: 528-545Crossref PubMed Scopus (137) Google Scholar, 6Tarr F. Dudas G. Tarr M. Racz R. Sasvari M. Tomcsanyi I. Analysis of the stable metabolite of endothelium-derived nitric oxide of internal mammary artery bypass grafts at the venous drainage system of the recipient coronary artery morphologic implications and consequences.Orv Hetil. 2002; 143: 2549-2552PubMed Google Scholar One must also question results from an experiment that did not use a group control; in addition, the small sample does not allow for definite conclusions, indicating the need for more research in this area. Reply to FilhoThe Journal of Thoracic and Cardiovascular SurgeryVol. 128Issue 3PreviewWe thank Filho and colleagues for their comments. Although the capacity of the internal thoracic artery (ITA) to adapt its caliber to the flow demand is well known, in our series of composite Y ITA–saphenous vein (SV) grafts the proportion of cases with clear graft malfunction (string or occlusion) that resulted in ischemia in the grafted territory was not negligible. Reversibility of the string sign has been anecdotally reported but cannot be accepted for sure, and in our series it was shown to be unlikely by the scintigraphic evidence of inducible ischemia. Full-Text PDF Open Archive" @default.
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• W4247346044 title "Studying the lumen in composite Y internal thoracic artery–saphenous vein grafts" @default.
• W4247346044 doi "https://doi.org/10.1016/s0022-5223(04)00776-7" @default.
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