Competitive flow and arterial graft a word of caution.

reliable, exclusively in appropriately selected situations. In creation of bypass grafts, durable completeness of revascularization and function of the ITA to the LAD bypass should not be compromised. We would suggest that the balanced bypass flow toward the LAD and the RCA is noticeably important to achieve an entire patency of the Y-graft for three-vessel regions. This study is not conclusive. Interactions between the target coronary branches and bypass grafts on the flow distribution and graft patency may be the next concerns. grafts with the right internal thoracic artery to left internal thoracic artery versus the left internal thoracic and radial artery: flow dynamics in the internal thoracic artery main stem. Failure of internal thoracic artery grafts: conclusions from coronary angiography mid-term follow-up. Determinants for successful sequential radial artery grafting to the left circumflex and right coronary arteries. Multiple off-pump coronary revascularization with 'aorta no-touch' technique using composite and sequential methods. Functional evaluation of internal mammary artery bypass grafts in the early and late postoperative periods. Vascular adaptation of the internal thoracic artery graft early and late after bypass surgery. Ham BM et al. Off-pump coronary artery bypass with complete avoidance of aortic manipulation. Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: a prospective randomized clinical , functional, and angiographic midterm evaluation. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. PN et al. Angiographic versus functional severity of coronary artery sten-oses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. A 10-year angiographic follow-up of competitive flow in sequential and composite arterial grafts. Competitive flow is a common finding in arterial grafting. Flow competition results from an equilibrium between the residual flow through the native coronary artery and the flow provided by the bypass graft at the anastomosis. This situation occurs when conductance of the graft closely matches that of the native circulation and is mainly dependent on stenosis severity and on graft H. Nakajima et al. / European Journal of Cardio-Thoracic Surgery 768