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Ann Thorac Surg 2001;72:1275-1281
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

{lambda} graft with the radial artery or free left internal mammary artery anastomosed to the right internal mammary artery: flow dynamics

Edvin Prifti, MDa,c, Massimo Bonacchi, MDb, Giacomo Frati, MDc, Piero Proietti, MDa, Gabriele Giunti, MDb, Marzia Leacche, MDa

a Division of Cardiac Surgery, University of Carreggi, Firenze, Italy
b Division of Cardiovascular Surgery, "Maggiore della Carità," Novara, Italy
c IRCCS NEUROMED, Pozzilli, Italy

Accepted for publication April 13, 2001.

Address reprint requests to Dr Bonacchi, Divisione di Cardiochirurgia, Policlinico di Careggi, Viale Morgagni, 85, 50134 Careggi Firenze, Italy
e-mail: edvinprifti{at}hotmail.com

Background. The aim of this study was to evaluate the outcome and flow dynamics of the {lambda} graft configuration, relative to a second arterial graft.

Methods. From 1998 to 2000, 47 patients (mean age 55.5 ± 4.7 years) with triple-vessel disease underwent arterial revascularization using the {lambda} graft. The in situ left internal mammary artery (LIMA) and right internal mammary artery (RIMA) were anastomosed to the left anterior descending (LAD) and obtuse marginal arteries, respectively. In 21 patients (group I) presenting proximal or middle-third LAD or right coronary (RC) arterial stenoses, the {lambda} graft was constructed by anastomosing the distal LIMA, as a free LIMA graft, to the RC and proximally to the in situ RIMA. In the other 26 patients (group II) presenting with middle-distal third LAD or RC arterial stenoses, the radial artery (RA) was used to construct the {lambda} graft. All patients underwent transthoracic echo color Doppler before and after an adenosine test at 1 week and 3 months after operation.

Results. There were no hospital deaths. Overall, 47 {lambda} grafts were constructed. There was no difference between baseline and maximal flows and coronary flow reserve (CFR) between groups. CFR at IMA stems increased in both groups within 3 months versus 1 week [LIMACFR = 2 ± 0.3 vs 2.3 ± 0.3 (p = 0.002) and RIMACFR = 2.2 ± 0.4 vs 2.5 ± 0.3 (p = 0.009) in group I, and LIMACFR = 2.12 ± 0.33 vs 2.4 ± 0.35 (p = 0.005) and RIMACFR = 2.17 ± 0.32 vs 2.52 ± 0.26 (p = 0.001) in group II]. At 3 months versus 1 week, the RIMAdiameteri (mm) at rest was 1.69 ± 0.32 versus 1.48 ± 0.2 (p = 0.015) in group I and 1.66 ± 0.3 versus 1.47 ± 0.2 (p = 0.01) in group II. At 6 ± 2.4 months, all patients were free of angina.

Conclusions. These data, almost identical for free LIMA and RA to RIMA using the {lambda} graft, demonstrate that RIMA flow reserve is adequate for multiple coronary anastomoses irrespective of the second arterial graft.




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