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Physiological Basis for the Systemic-to-Coronary Artery Bypass Graft: Inadequacy of the Internal Mammary Artery for This Purpose and Appraisal of the Ascending Aorta as Its Proximal Site

Physiological Basis for the Systemic-to-Coronary Artery Bypass Graft: Inadequacy of the Internal... Abstract Since Murray et al1 reported the feasibility of a systemicto-coronary artery bypass in 1954, many articles have appeared which have described surgical techniques to anastomose the internal mammary artery to the anterior descending or circumflex branch of the left coronary artery by means of nonsuture techniques,2 temporary internal shunts,3 vascular anastomosing staplers,4 or extracorporeal circulation.5 These technical contributions were aimed to improve the patency rate of the coronary artery anastomosis without reference to the physiological background of the coronary circulation. Coronary bypass inflow is determined by the vascular resistance of the coronary arterial system and the pressure gradient across the anastomosis. If the coronary vascular resistance is constant, the pressure gradient will determine the inflow. It is known that pulsatile pressure contours change as they propagate along the aorta.6 There is also a time lag of pulse wave propagation between the aortic root and References 1. Murray, G., et al: Anastomosis of Systemic Artery to the Coronary Artery , Canad Med Assoc J 71:594-597 ( (Dec) ) 1954. 2. Carter, E.L., and Roth, E.J.: Direct Nonsuture Coronary Artery Anastomosis in the Dog , Ann Surg 148:212-218 ( (Aug) ) 1968.Crossref 3. Absolon, K.B., et al: Surgical Treatment of Occlusive Coronary Artery Disease by Endarterectomy or Anastomotic Replacement , Surg Gynec Obstet 103:180-185 ( (Aug) ) 1956. 4. Carroll, S.E.: Experimental Anastomosis of the Left Internal Mammary Artery to the Divided Circumflex Coronary Artery Using the NRC-Vogelfanger Stapling Device , Canad J Surg 7:463-469 ( (Oct) ) 1964. 5. Julian, O.C., et al: Direct Surgical Procedures on the Coronary Arteries: Experimental Studies , J Thorac Surg 34:654-660 ( (Nov) ) 1957. 6. Luchsinger, P.C., et al: Instantaneous Pressure Distribution Along the Human Aorta , Circ Res 15:503-510 ( (Dec) ) 1964.Crossref 7. Schuldt, H.H., and Krause, H.: Coronary Inflow After Systemic-to-coronary Artery Anastomosis in Dogs , Amer Heart J 72:359-368 ( (Sept) ) 1966.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Physiological Basis for the Systemic-to-Coronary Artery Bypass Graft: Inadequacy of the Internal Mammary Artery for This Purpose and Appraisal of the Ascending Aorta as Its Proximal Site

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Publisher
American Medical Association
Copyright
Copyright © 1970 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1970.01340190019006
Publisher site
See Article on Publisher Site

Abstract

Abstract Since Murray et al1 reported the feasibility of a systemicto-coronary artery bypass in 1954, many articles have appeared which have described surgical techniques to anastomose the internal mammary artery to the anterior descending or circumflex branch of the left coronary artery by means of nonsuture techniques,2 temporary internal shunts,3 vascular anastomosing staplers,4 or extracorporeal circulation.5 These technical contributions were aimed to improve the patency rate of the coronary artery anastomosis without reference to the physiological background of the coronary circulation. Coronary bypass inflow is determined by the vascular resistance of the coronary arterial system and the pressure gradient across the anastomosis. If the coronary vascular resistance is constant, the pressure gradient will determine the inflow. It is known that pulsatile pressure contours change as they propagate along the aorta.6 There is also a time lag of pulse wave propagation between the aortic root and References 1. Murray, G., et al: Anastomosis of Systemic Artery to the Coronary Artery , Canad Med Assoc J 71:594-597 ( (Dec) ) 1954. 2. Carter, E.L., and Roth, E.J.: Direct Nonsuture Coronary Artery Anastomosis in the Dog , Ann Surg 148:212-218 ( (Aug) ) 1968.Crossref 3. Absolon, K.B., et al: Surgical Treatment of Occlusive Coronary Artery Disease by Endarterectomy or Anastomotic Replacement , Surg Gynec Obstet 103:180-185 ( (Aug) ) 1956. 4. Carroll, S.E.: Experimental Anastomosis of the Left Internal Mammary Artery to the Divided Circumflex Coronary Artery Using the NRC-Vogelfanger Stapling Device , Canad J Surg 7:463-469 ( (Oct) ) 1964. 5. Julian, O.C., et al: Direct Surgical Procedures on the Coronary Arteries: Experimental Studies , J Thorac Surg 34:654-660 ( (Nov) ) 1957. 6. Luchsinger, P.C., et al: Instantaneous Pressure Distribution Along the Human Aorta , Circ Res 15:503-510 ( (Dec) ) 1964.Crossref 7. Schuldt, H.H., and Krause, H.: Coronary Inflow After Systemic-to-coronary Artery Anastomosis in Dogs , Amer Heart J 72:359-368 ( (Sept) ) 1966.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1970

References