Related Experiment Videos
The Y graft: myocardial revascularization with both internal thoracic arteries. Evaluation of eighty cases with
S Chocron1, J P Etievent, F Schiele
1Department of Thoracic and Cardiovascular Surgery, Hôpital Sam-Jacques, Besancon, France.
Insights
This study evaluated Y grafts using the right and left internal thoracic arteries for coronary artery bypass surgery. While left internal thoracic artery grafts showed high patency, right internal thoracic artery grafts had lower patency rates, indicating a need for careful technique.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Anastomosis
Background:
- Bilateral in situ internal thoracic arteries are limited by sternal devascularization, pedicle length, and midline crossing.
- Coronary artery bypass grafting (CABG) traditionally uses single internal thoracic arteries or vein grafts.
Purpose of the Study:
- To evaluate the efficacy of Y grafts created by anastomosing the free right internal thoracic artery (RITA) to the side of the in situ left internal thoracic artery (LITA).
- To assess graft patency and clinical outcomes of this Y-graft technique in patients undergoing CABG.
Main Methods:
- Y grafts were performed in 80 patients (aged 41-74) between May 1991 and September 1992, using two techniques across two groups (34 patients in group 1, 46 in group 2).
- LITA was used for the left anterior descending artery in 79 cases. RITA was anastomosed to diagonal, marginal, circumflex, or right coronary arteries.
- Seventy-five saphenous vein grafts were used in 58 patients as complementary bypasses.
Main Results:
- Operative mortality was 2.5%. Perioperative myocardial infarcts occurred in 2.5% and sternal wound infections in 3.7% of patients.
- Angiographic follow-up (6-25 months) revealed 97% patency for LITA grafts (60/62) and 63% patency for RITA grafts (39/62).
- Patency rates for RITA grafts varied by technique: 48% in group 1 (12/25) versus 73% in group 2 (27/37).
Conclusions:
- The Y graft technique using RITA anastomosed to LITA is feasible but requires meticulous attention to RITA length.
- While LITA grafts demonstrate excellent long-term patency, RITA graft patency in this series was suboptimal, particularly with the first technique.
- Further refinement and extensive training are necessary to optimize outcomes with this specific Y-graft configuration.
Abstract:
The use of bilateral in situ internal thoracic arteries is restricted by the risk of sternal devascularization, the length of the pedicle, and the necessity to avoid crossing the midline. The aim of this study is to evaluate Y grafts achieved by anastomosing the proximal end of the free right internal thoracic artery to the side of the attached left internal thoracic artery. Y grafts were performed in 80 patients, aged 41 to 74 years (mean age 58.6 years) between May 1991 and September 1992. Two different techniques were used. Thirty-four patients were included in group 1 and 46 in group 2. Seventy-nine grafts were performed from the left internal thoracic artery to the left anterior descending artery. The right internal thoracic artery was anastomosed to the diagonal artery (5 times), the marginal branch (67 times), the circumflex artery (7 times) and the right coronary artery (2 times). Seventy-five complementary saphenous vein bypasses were performed in 58 patients. Operative mortality was 2.5%. Two patients had perioperative myocardial infarcts (2.5%) on nonbypassed sites. Three patients had sternal wound infections (3.7%). Sixty-two patients (80%) were reexamined by angiography at month 6-25 in group 1 and 37 in group 2. Sixty left internal thoracic artery bypass grafts (97%) were patent versus 39 right internal thoracic artery bypass grafts (63%). In group 1, 23 of 25 left internal thoracic artery bypass grafts were patient (92%) versus 12 right internal thoracic artery grafts (48%). In group 2, all 37 left internal thoracic artery bypass grafts were patent (100%) versus 27 right internal thoracic artery grafts (73%). With this procedure, particular attention must be paid to the length of the right internal thoracic artery, and extensive training is required.