Ann Thorac Surg 2005;79:753
© 2005 The Society of Thoracic Surgeons
Optimizing Use of the Internal Thoracic Arteries for Total Myocardial Revascularization: Reply
Calin Vicol, MD
Ludwig Maximilians University, Grosshadern Medical Center, Marchioninistrasse 15, Munich 81377, Germany
To the Editor:
The TY graft described by us  and the graft described by Prapas and colleagues  are intended to revascularize three to five coronary arteries. The loop technique as featured by Stoica and colleagues is limited to only three vessels, according to Dr Stoica's letter.
Doctor Stoica states that a disadvantage of the TY and graft techniques is the necessity to exactly measure the length of the short free graft segments and that an error in this measurement may compromise graft patency. However, his loop technique is actually a step in the construction of a TY or graft and can be also affected by a wrong appreciation of segment length. Usually we oversize lengths of short, free graft segments at the time of TY graft construction and determine the definitive length before performing each anastomosis to target coronary arteries. In this way, we avoid the risk of length mismatch or kinking.
We used the TY graft construction in 46 patients without technical dificulties and with good results. We did not compare it with the loop technique for constructing TY or grafts; therefore, we cannot state if it is more reproducible and easy to perform, as Dr Stoica states.
Nevertheless, the loop technique seems to be an ingenious method to construct a TY or graft.
- 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]