Intercostal Artery as a Pedicled Graft for Myocardial Revascularization: An Animal Experimental Study

Abstract

An experimental study was conducted in 12 dogs to evaluate the technical feasibility of using the 8th and 9th intercostal arteries as pedicled grafts for myocardial revascularization. In phase 1 (n = 4), the technique to harvest the intercostal artery as a pedicled graft posteriorly based on the thoracic aorta was developed. In phase 2 (n = 4), the sternotomy approach was compared to posterolateral thoracotomy for access. Pedicles were routed to various coronary arteries via a pericardial window. In phase 3 (n = 4), evaluation was confined to the left 8th and 9th pedicles via median sternotomy approach, as this is more clinically applicable. Blood flows and external diameters were measured. Mid sternotomy approach to the 8th and 9th intercostal arteries on both the right and left was feasible and technically adequate grafts were obtainable. These pedicled grafts reached the branches of both the left circumflex and right coronary artery. Mean blood flows in the left 8th and 9th intercostal artery grafts were 25 ± 2.58 and 27 ± 2.1 mL/min with mean external diameters of 0.44 ± 0.027 and 0.48 ± 0.028 mm, respectively, and a mean body weight of 25 kg. We conclude that the 8th and 9th intercostal arteries can technically be harvested as pedicled grafts via median sternotomy and can be used to revascularize the left circumflex coronary system.

Key Words:

• arterial grafts
• CABG
• conduits
• coronary artery bypass
• graft patency
• intercostal artery
• MIDCAB
• minimally invasive coronary bypass
• myocardial revascularization
• total arterial revascularization