Comprehensive Comparison of Different BITA Graft Configurations: a Computational Study Integrating TTFM and Hemodynamic Predictors

Overview

Journal Med Biol Eng Comput

Publisher Springer

Specialties Biomedical Engineering
Medical Informatics

Date 2025 Mar 4

PMID 40038180

Authors

Ahmad Masoudi

Hossein Ali Pakravan

Affiliations

Soon will be listed here.

Abstract

Bilateral internal thoracic artery (BITA) grafting utilizes both the left (LITA) and right (RITA) internal thoracic arteries simultaneously and is recommended in the literature. However, the optimal configuration for BITA grafting remains uncertain. In this study, three-dimensional numerical simulations of different BITA configurations were conducted to identify the optimal configuration and assess their performance using the fractional flow reserve (FFR), transit time flow meter (TTFM), and hemodynamic parameters. The vessel geometry of a patient who underwent a BITA grafting with a Y-graft configuration was extracted from CT angiography images, and three other configurations (pedicle, LITA as free graft, and RITA as free graft) with different degrees of stenosis were reconstructed. Results showed that, in mild to moderate stenosis (FFR > 0.7), the Y-graft configuration was less favorable for graft quality, as it had higher pulsatility index (PI) and systolic reverse flow (SRF) values, leading to increased competitive flow. However, as stenosis severity increased, these differences decreased, and for severe stenosis, the results were similar for all BITA configurations. Furthermore, the results showed that the Y-graft configuration was less effective in reducing TAWSS compared to other configurations. Oscillatory shear index (OSI) and relative residence time (RRT) did not show significant differences.

References

Halfwerk F, Spoor P, Mariani S, Hagmeijer R, Grandjean J . Intraoperative transit time flow measurements during off-pump coronary artery bypass surgery: The impact of coronary stenosis on competitive flow. J Card Surg. 2021; 37(2):305-313. PMC: 9298124. DOI: 10.1111/jocs.16103. View

Aboul-Hassan S, Stankowski T, Marczak J, Perek B, Olasinska-Wisniewska A, Urbanowicz T . Long-term outcomes of patients receiving right internal thoracic artery or radial artery as a second arterial conduit. A propensity score matching study. Int J Cardiol. 2022; 370:136-142. DOI: 10.1016/j.ijcard.2022.10.156. View

Hamilton G, Raman J, Moten S, Matalanis G, Rosalion A, Dimagli A . Radial artery vs. internal thoracic artery or saphenous vein grafts: 15-year results of the RAPCO trials. Eur Heart J. 2023; 44(26):2406-2408. DOI: 10.1093/eurheartj/ehad108. View

Gaudino M, Samadashvili Z, Hameed I, Chikwe J, Girardi L, Hannan E . Differences in Long-term Outcomes After Coronary Artery Bypass Grafting Using Single vs Multiple Arterial Grafts and the Association With Sex. JAMA Cardiol. 2020; 6(4):401-409. PMC: 7758835. DOI: 10.1001/jamacardio.2020.6585. View

Barili F, Onorati F, DErrigo P, Rosato S, Biancari F, Baglio G . Bilateral Internal Thoracic Arteries Improve 10-Year Outcomes of Coronary Artery Bypass Grafting. Ann Thorac Surg. 2023; 116(1):52-60. DOI: 10.1016/j.athoracsur.2023.02.035. View

Lytle B, Blackstone E, Sabik J, Houghtaling P, Loop F, Cosgrove D . The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg. 2004; 78(6):2005-12. DOI: 10.1016/j.athoracsur.2004.05.070. View

Zhu Y, Lingala B, Wang H, Woo Y . Bilateral vs Single Internal Mammary Artery Grafts for Coronary Artery Bypass in the United States. Ann Thorac Surg. 2020; 111(2):629-635. DOI: 10.1016/j.athoracsur.2020.05.049. View

Navia D, Espinoza J, Vrancic M, Piccinini F, Camporrotondo M, Dorsa A . Bilateral internal thoracic artery grafting in elderly patients: Any benefit in survival?. J Thorac Cardiovasc Surg. 2020; 164(2):542-549. DOI: 10.1016/j.jtcvs.2020.09.101. View

Puskas J, Sadiq A, Vassiliades T, Kilgo P, Lattouf O . Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients. Ann Thorac Surg. 2012; 94(3):710-5. DOI: 10.1016/j.athoracsur.2012.03.082. View

10.

Caliskan E, de Souza D, Boning A, Liakopoulos O, Choi Y, Pepper J . Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol. 2019; 17(3):155-169. DOI: 10.1038/s41569-019-0249-3. View

11.

Sakaguchi G, Tadamura E, Ohnaka M, Tambara K, Nishimura K, Komeda M . Composite arterial Y graft has less coronary flow reserve than independent grafts. Ann Thorac Surg. 2002; 74(2):493-6. DOI: 10.1016/s0003-4975(02)03729-3. View

12.

Ben-Gal Y, Gordon A, Ziv-Baran T, Farkash A, Mohr R, Kramer A . Late Outcomes of In Situ Versus Composite Bilateral Internal Thoracic Artery Revascularization. Ann Thorac Surg. 2020; 112(5):1441-1446. DOI: 10.1016/j.athoracsur.2020.11.041. View

13.

Glineur D, Boodhwani M, Hanet C, de Kerchove L, Navarra E, Astarci P . Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery: A Prospective Randomized Trial. Circ Cardiovasc Interv. 2016; 9(7). PMC: 4949001. DOI: 10.1161/CIRCINTERVENTIONS.115.003518. View

14.

Bakaeen F, Ghandour H, Ravichandren K, Zhen-Yu Tong M, Soltesz E, Johnston D . Right Internal Thoracic Artery Patency Is Affected More by Target Choice Than Conduit Configuration. Ann Thorac Surg. 2021; 114(2):458-466. DOI: 10.1016/j.athoracsur.2021.09.015. View

15.

Lu A, Al Abri Q, Amirkhosravi F, Ramchandani M . Surgical salvage of left internal mammary artery graft ostial stenosis. JTCVS Tech. 2022; 14:119-121. PMC: 9366953. DOI: 10.1016/j.xjtc.2022.05.018. View

16.

Paliouras D, Rallis T, Gogakos A, Asteriou C, Chatzinikolaou F, Georgios T . Surgical anatomy of the internal thoracic arteries and their branching pattern: a cadaveric study. Ann Transl Med. 2015; 3(15):212. PMC: 4583587. DOI: 10.3978/j.issn.2305-5839.2015.09.03. View

17.

Brooks D, Goodwin J, Seaman G . Interactions among erythrocytes under shear. J Appl Physiol. 1970; 28(2):172-7. DOI: 10.1152/jappl.1970.28.2.172. View

18.

Kim H, Vignon-Clementel I, Coogan J, Figueroa C, Jansen K, Taylor C . Patient-specific modeling of blood flow and pressure in human coronary arteries. Ann Biomed Eng. 2010; 38(10):3195-209. DOI: 10.1007/s10439-010-0083-6. View

19.

Taylor C, Fonte T, Min J . Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol. 2013; 61(22):2233-41. DOI: 10.1016/j.jacc.2012.11.083. View

20.

Faes T, Meer R, Heyndrickx G, Kerkhof P . Fractional Flow Reserve Evaluated as Metric of Coronary Stenosis - A Mathematical Model Study. Front Cardiovasc Med. 2020; 6:189. PMC: 6970943. DOI: 10.3389/fcvm.2019.00189. View