Ann Thorac Surg 2005;79:753
© 2005 The Society of Thoracic Surgeons
Correspondence
Optimizing Use of the Internal Thoracic Arteries for Total Myocardial Revascularization
Lucian Stoica, MD, PhD,
Sidney Chocron, MD, PhD,
Joseph Philippe Etievent, MD
Jean Minjoz Hospital, Department of Thoracic and Cardiovascular Surgery, 3 Bd Fleming, Besançon 25000, France
To the Editor:
Vicol and associates [1] presented a technique that allows all arterial coronary revascularization using a composite graft made with the left internal thoracic artery (LITA) and the radial artery (RA), called the TY graft. It permits three or four coronary anastomoses in the end-to-side fashion. The TY graft is similar to the 
graft described by Prapas and colleagues [2] that is made with two skeletonized internal thoracic arteries (ITAs). The disadvantage of the two techniques is that we must precisely measure and cut segments of LITA, RITA, or RA before the anastomoses are done on the left descending artery (LAD) or on the most distal artery on the lateral or posterior wall. An error of measurement may compromise these bypass grafts and the entire operation.
We use the mammary loop technique which permits a Y graft using only a LITA or a graft using two ITAs [3, 4]. The distal end of the skeletonized LITA is anastomosed to the proximal LITA to form a loop. That will be cut open just before the coronary anstomosis at the desirable level to provide an adjustable Y graft. This kind of Y graft permits bypass grafts the LAD, diagonal artery, ramus intermedius, or a high lateral artery when the anatomy for a sequential bypass graft is inappropriate. The loop technique simplifies graft construction. First we made a Y graft with two skeletonized ITAs. The loop is made by anastomosing the distal end of the LITA to the RITA. After section of the loop, we obtain a graft. There are four variants of loop construction for a graft: LITA on RITA, LITA on LITA, RITA on LITA, and RITA on RITA; so we can adapt the graft for each case. We used these techniques in 20 patients who underwent on-pump or off-pump surgery. These mammary loop techniques allow construction of adjustable composite grafts with both ITAs. In our experience this method is sure, reproducible, and easier to perform than the "classic graft" or the TY graft.
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References
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- Vicol C, Nollert G, Mair H, Reichart B. Optimizing use of the octopus system for off-pump total arterial myocardial revascularization with the TY graft Ann Thorac Surg 2004;77:731-733.[Abstract/Free Full Text]
- Prapas SN, Anagnostopoulos CE, Kotsis VN, et al. A new pattern for using both thoracic arteries to revascularize the entire heartthe pi-graft. Ann Thorac Surg 2002;73:1990-1992.[Abstract/Free Full Text]
- Stoica L, Chocron S, Falcoz PE, Kaili D, Etievent JP. The mammary loop—or how to do an adjustable "Y" graft with the left internal thoracic artery. Ann Thorac Surg 2004;78:1103–4..
- Stoica L, Chocron S, Falcoz PE, Kaili D, Etievent JP. How to tailor a "" graft for complex myocardial revascularization—a variant of the mammary loop technique. Ann Thorac Surg 2004. In press..
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