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Ann Thorac Surg 1999;68:1612-1618
© 1999 The Society of Thoracic Surgeons

Original Articles

Exclusive Y graft operation for multivessel coronary revascularization

Alistair G. Royse, FRACSa, Colin F. Royse, FANZCAb, Jai S. Raman, FRACSa

a Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
b Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia

Address reprint requests to Dr Royse, Department of Cardiothoracic Surgery, Royal Melbourne Hospital, PO Box 2135, Parkville, Victoria 3050, Australia
e-mail: alistair.royse{at}nwhcn.org.au

Background. The pedicled (in-situ) left internal mammary artery grafted to the left anterior descending artery has a very high late patency and reduces late mortality following coronary artery bypass surgery. A technique is described which achieves total arterial revascularization in patients with multivessel coronary disease and which is also entirely pedicled.

Methods. Using the left internal mammary artery and radial artery joined as a composite Y graft, all coronary territories may be grafted.

Results. One in-hospital death from 464 patients (0.2%) occurred. Age (mean ± standard error) was 64.7 ± 0.5 years and number of distal anastomoses 3.4 ± 0.04. Of 1,681 patients from Royal Melbourne Hospital, 346 had this operation. Comparison found no preoperative selection bias and no postoperative differences in complications. Actuarial survival was 0.98 ± 0.01 at 36.1 ± 0.3 months.

Conclusions. Total arterial revascularization may be performed using the left internal mammary artery and radial artery as a composite Y graft. There was no increase in complications. This technique preserves the left internal mammary artery to left anterior descending artery graft.




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