Vascular adaptation of the internal thoracic artery graft early and late after bypass surgery Beat H. Walpoth, MD, Markus Schmid, MD, Anna Schwab, MD,

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Vascular adaptation of the internal thoracic artery graft early and late after bypass surgery Beat H. Walpoth, MD, Markus Schmid, MD, Anna Schwab, MD, Andreas Bosshard, MD, Friedrich Eckstein, MD, Thierry Carrel, MD, Otto M. Hess, MD The Journal of Thoracic and Cardiovascular Surgery Volume 136, Issue 4, Pages 876-883 (October 2008) DOI: 10.1016/j.jtcvs.2008.05.029 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Study protocol. The total number of patients is 30. Group A contains 17 patients. Eight patients of group A have been studied after 3 months and 9 patients after 10 months of follow-up. Group B contains 13 patients studied intraoperatively. ITA, Internal thoracic artery; SVG, saphenous vein graft. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 876-883DOI: (10.1016/j.jtcvs.2008.05.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Original recording of flow velocity measurements of the internal thoracic artery (ITA) graft (left) and the saphenous vein graft (SVG; right) 3 months postoperatively. The flow velocity curve during maximal vasodilation with adenosine (top) and trend analysis (bottom) is shown. Coronary flow reserve is 2.4 for the ITA graft and 3.0 for the SVG. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 876-883DOI: (10.1016/j.jtcvs.2008.05.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Bypass flow. Baseline values compared with hyperemic flow are shown intraoperatively and 3 months and 10 months after surgical intervention for the internal thoracic artery (ITA) graft (top) and the saphenous vein graft (SVG; bottom). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 876-883DOI: (10.1016/j.jtcvs.2008.05.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Baseline and hyperemic flow (internal thoracic artery [ITA] graft vs saphenous vein graft [SVG]). Baseline flow (top) and hyperemic flows (bottom) for the ITA graft compared with the SVG are shown intraoperatively and 3 and 10 months postoperatively. Baseline and hyperemic flows are significantly reduced for the ITA graft compared with the SVG intraoperatively (P < .01). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 876-883DOI: (10.1016/j.jtcvs.2008.05.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Coronary flow reserve (CFR) for the internal thoracic artery (ITA) graft compared with the saphenous vein graft (SVG) is shown intraoperatively and 3 and 10 months postoperatively. There is no difference between the ITA graft and the SVG. CFR is significantly increased for both the ITA graft and the SVG 3 and 10 months after the operation (P < .01). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 876-883DOI: (10.1016/j.jtcvs.2008.05.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Correlation between resting graft flow and graft diameter early (3 months) and late (10 months) postoperatively. The internal thoracic artery (ITA) graft diameter increased by 16%, and the saphenous vein graft (SVG) diameter decreased by 7%. There is a significant correlation both for the ITA graft and the SVG, with a better Pearson's regression for the ITA graft (r = 0.86) than for the SVG (r = 0.60). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 876-883DOI: (10.1016/j.jtcvs.2008.05.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions