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Exclusive Y graft operation for multivessel coronary revascularization
A G Royse1, C F Royse, J S Raman
1Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia. alistair.royse@nwhcn.org.au
The Annals of Thoracic Surgery
|December 10, 1999
Summary
Total arterial revascularization using a composite Y graft of the left internal mammary artery and radial artery is safe and effective for multivessel coronary disease, maintaining excellent long-term survival.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease Management
Background:
- The pedicled left internal mammary artery (LIMA) to the left anterior descending (LAD) artery offers high late patency and reduced mortality in coronary artery bypass surgery.
- A novel technique for total arterial revascularization in multivessel coronary disease using entirely pedicled grafts is presented.
Purpose of the Study:
- To evaluate the safety and efficacy of a composite Y graft technique for total arterial revascularization.
- To assess the feasibility of using both the left internal mammary artery and radial artery in a Y configuration.
Main Methods:
- Utilized a composite Y graft combining the left internal mammary artery and radial artery to revascularize all coronary territories.
- Performed total arterial revascularization in patients with multivessel coronary disease.
Main Results:
- A single in-hospital death occurred in 464 patients (0.2%).
- The mean age was 64.7 years, with an average of 3.4 distal anastomoses.
- Actuarial survival was 98% at 36 months, with no increase in postoperative complications compared to other methods.
Conclusions:
- Total arterial revascularization is achievable using a composite Y graft of the left internal mammary artery and radial artery.
- This technique demonstrated a favorable safety profile and excellent long-term survival.
- The method preserves the integrity of the LIMA-LAD graft while enabling complete revascularization.