Total Arterial Off-Pump Coronary Revascularization with Multiple Y Arterial Composite Grafts

Kim, Do kyun; Lee, Kyo Joon; Joo, Hyun Chul; Li, Gyjong; Ahn, Jiyoung; Shim, Yunhee; Yoo, Kyung Jong

Abstract

BACKGROUND: Complete arterial off-pump coronary artery bypass grafting (OPCAB) by sequential anastomoses with one or two arterial grafts provides favorable outcomes. However, problems of insufficient graft length, hypoperfusion, kinking of graft, and unfavorable course of graft may be encountered. To solve these problems, we have used different technique with multiple arterial Y composite graft to allow end-to-side rather than sequential anastomoses and evaluated the results of this method. MATERIAL AND METHOD: Between February 2003 and October 2004, 71 patients underwent total arterial OPCAB using multiple arterial Y composite grafts with left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA). We divided RA into multiple segments by number of distal target site after measuring of individual proper length and constructed arterial composite graft. One of segments was sutured end-to-side to LIMA and other segment was sutured end-to-side to the previously constructed radial graft. Postoperative graft patency was evaluated in 61 patients by multi-slice computed tomography. RESULT: An average of 2.5+/-0.6 arteries and 3.7+/-0.7 distal anastomoses per patient were done. There was no perioperative myocardial infarction, clinical hypoperfusion syndromes, and operative mortality. Postoperative mean CK-MB level was 17.4+/-29.7 IU/L. Overall graft patency was 99.1% (214/216)(LIMA: 100%, RA: 98.4%, RIMA: 100%).
CONCLUSION
This technique allows total arterial OPCAB without technical problems and provides excellent early clinical results and graft patency. We believe that this technique is more convenient in the obtuse marginal area compared to sequential technique, and helpful in patients who require complex arterial grafting.