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The results of radial artery Y-graft for complete arterial revascularization
Ahmet Turan Yilmaz1, Ertugrul Ozal, Nadir Barindik
1Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey. atyilmaz@gata.edu.tr
Insights
This study introduces a radial artery (RA) Y-graft technique for complete arterial coronary artery bypass grafting (CABG). This method offers excellent early patency and simplifies multi-vessel revascularization, reducing operating time and trauma.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Complete arterial coronary artery bypass grafting (CABG) using multiple arterial grafts can prolong operating times and increase patient trauma.
- Sequential grafting techniques offer an alternative for multi-vessel coronary artery disease (CAD) but can be technically challenging.
- The radial artery (RA) is a viable conduit for CABG, but its utilization in Y-graft configurations requires specific techniques.
Purpose of the Study:
- To present the experience and outcomes of using a radial artery (RA) Y-graft technique for routine complete arterial revascularization.
- To evaluate the feasibility and efficacy of this RA Y-graft approach in patients with multi-vessel coronary artery disease (CAD).
- To compare the results of the RA Y-graft technique with conventional multiple arterial grafting methods.
Main Methods:
- A retrospective analysis of 127 patients undergoing complete arterial revascularization with left internal mammary artery (LIMA) and RA Y-grafts between January 1996 and November 2001.
- The RA Y-graft technique involved dividing the harvested RA to create composite grafts for end-side anastomoses, preserving conduit length.
- Comparison with a cohort of 109 patients who received complete arterial CABG using multiple arterial grafts during the same period.
Main Results:
- The RA Y-graft technique was successfully applied in patients with multi-vessel disease, including triple-vessel disease (73.2%).
- Mean operating time was 185 minutes, with no operative mortality or morbidity observed.
- Excellent early graft patency was documented: LIMA 100% and RA 98.1% at 2-30 months follow-up.
Conclusions:
- The RA Y-graft technique is a valuable alternative for cardiac surgeons performing complete arterial revascularization.
- This approach enables complete arterial revascularization in multi-vessel CAD using single internal mammary artery and radial artery grafts.
- The technique demonstrates excellent early clinical and angiographic results, offering a simplified and effective option.
Objective:
Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma in complete arterial coronary artery bypass grafting (CABG). Using sequential grafting techniques, CABG is possible with only two arterial grafts in multi-vessel coronary artery disease (CAD). However, sequential grafting may not be convenient for all circumstances and sometimes surgical technique may be challenging. We present our experience in the use of radial artery (RA) Y-graft on a routine basis.
Methods:
Between January 1996 and November 2001, 127 patients (aged 63+/-8 years) with the diagnosis of multi-vessel disease underwent complete arterial revascularization using left internal mammarian artery (LIMA) and RA. Left ventricular ejection fraction ranged from 23 to 65% (mean 51+/-11%). Triple-vessel disease was present in 73.2% of patients. We used the division technique of RA during harvesting and formation of one or more composite Y-grafts of the RA itself to allow end-side rather than sequential anastomoses without any significant decrease the usable conduit length. The results of this technique were compared with the data of patients (n=109) who underwent completely arterial CABG with the use of the multiple arterial grafts in the same period.
Results:
LIMA was anastomosed to the left anterior descending coronary artery (LAD) system in all patients. Two to four (mean 2.8+/-0.6) anastomoses were performed with RA Y-graft per patient. Proximal end of the radial graft was anastomosed to LIMA (60.6%) or aorta (39.4%). Mean operating time was 185 (45 min; bypass time, 68+/-23 min; and cross-clamp time, 49+/-17 min). Perioperative intraaortic balloon pump was necessary in five patients (3.9%). There was no operative mortality or morbidity. During the follow-up period of 2-30 months, none of the patients had any complication. Postoperative coronary angiography in 54 patients (42.5%) documented excellent early patency rates (LIMA 100%, and RA 98.1%).
Conclusions:
We believe that keeping our technique in their armamentarium will be useful for cardiac surgeons as an alternative method during complete arterial revascularization. This approach allows for complete arterial revascularization in multi-vessel CAD using only single IMA and RA grafts with excellent early results.
