Total Arterial Revascularization with a Single Y-Composite Graft for Triple-Vessel Disease: Comparison of 2- and 3-Artery Grafts


  • Ji-Hyuk Yang
  • Kiick Sung
  • Young Tak Lee
  • Kay-Hyun Park
  • Tae-Gook Jun
  • Pyo Won Park



Background: Treating triple-vessel disease by grafting a single Y-composite graft with 1 arterial conduit attached to the side of the internal thoracic artery is sometimes not used because of the possibility of hypoperfusion.

Methods: Between March 2001 and June 2003, 271 patients who underwent total arterial revascularization for triple-vessel disease were divided into 2 groups. Group I (n = 188) received a Y-composite graft with 2 arterial conduits, and group II (n = 83) received a Y-composite graft and 1 additional arterial conduit. We retrospectively reviewed the data and compared the clinical results of the 2 groups.

Results: The numbers of distal anastomoses were 3.9 ± 0.7 (mean ± SD) per patient in group I and 4.1 ± 0.8 in group II (P = .021). There were 2 in-hospital deaths in group I and none in group II (difference not statistically significant). Perioperative myocardial infarction occurred in 2 patients in group I and none in group II (not statistically significant). No patient in either group needed a new intra-aortic balloon pump postoperatively, and no patients experienced hypoperfusion syndrome. A cerebrovascular accident occurred in 1 patient of each group. During the follow-up period (15.9 ± 6.7 months in group I, 25.2 ± 8.3 months in group II), 5 patients died (4 in group I, 1 in group II). Two patients in group I and 1 patient in group II needed an intervention on the right coronary artery, but the other patients required no additional procedures and had no symptoms of angina. There were no statistically significant differences in survival and reintervention-free survival between the 2 groups.

Conclusion: Single Y-composite grafts with 2 arterial conduits may be a safe and effective strategy for treating triple-vessel disease.


Hirose H, Amano A, Takanashi S, Takahashi A. 2002. Coronary artery bypass grafting using the gastroepiploic artery in 1,000 patients. Ann Thorac Surg 73:1371-9.nKawasuji M, Sakakibara N, Takemura H, Tedoriya T, Ushijima T, Watanabe Y. 1996. Is internal thoracic artery grafting suitable for a moderately stenotic coronary artery? J Thorac Cardiovasc Surg 112:253-9.nLloyd CT, Ascione R, Gupta S, Angelini GD. 1999. Abdominal abscess: later complication after gastroepiploic coronary artery bypass grafting. Eur J Cardiothorac Surg 16:371-3.nLust RM, Zeri RS, Spence PA, et al. 1994. Effect of chronic native >flow competition on internal thoracic artery grafts. Ann Thorac Surg 57:45-50.nLytle BW. Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes. J Thorac Cardiovasc Surg 126:5-6.nMarkwirth T, Hennen B, Scheller B, Schafers HJ, Wendler O. 2001. Flow wire measurements after complete arterial coronary revascularization with T-grafts. Ann Thorac Surg 71:788-93.nNakayama Y, Sakata R, Ura M. 2001. Growth potential of left internal thoracic artery grafts: analysis of angiographic findings. Ann Thoracic Surg 71:142-7.nWendler O, Hennen B, Demertzis S, et al. 2000. Complete arterial revascularization in multivessel coronary artery disease with 2 conduits (skeletonized grafts and T grafts). Circulation 102:III-79-83.nSeki T, Kitamura S, Kawachi K, et al. 1992. A quantitative study of postoperative luminal narrowing of the internal thoracic artery graft in coronary artery bypass surgery. J Thorac Cardiovasc Surg 104:1532-8.nSpyrou N, Khan MA, Rosen SD, et al. 2000. Persistent but reversible coronary microvascular dysfunction after bypass grafting. Am J Physiol Heart Circ Physiol 279:H2634-40.nSung K, Lee YT, Park KH, Jun TG, Park PW, Yang JH. 2003. Beating heart revascularization using only bilateral internal thoracic arteries for triple-vessel disease: early angiographic findings. Heart Surg Forum 6:336-40.nTector A, McDonald ML, Kress DC, Downey FX, Schmahl TM. 2001. Purely internal thoracic artery grafts: outcomes. Ann Thorac Surg 72:450-5.nTrick WE, Scheckler WE, Tokars JI, et al. 2000. Risk factors for radial artery harvest site infection following coronary artery bypass graft surgery. Clin Infect Dis 30:270-5.nVerhofste MA, Tam SK. 1995. Diaphragmatic hernia after right gastroepiploic artery coronary artery bypass grafting. Ann Thorac Surg 60:458-9.nOchi M, Hatori N, Fujii M, Saji Y, Tanaka S, Honma H. 2001. Limited flow capacity of the right gastroepiploic artery graft: postoperative echocardiographic and angiographic evaluation. Ann Thorac Surg 71:1210-4.nPick AW, Orszulak TA, Anderson BJ, Schaff HV. 1997. Single versus bilateral internal mammary artery grafts: 10-year outcome analysis. Ann Thorac Surg 64:599-605.nRuengsakulrach P, Sinclair R, Komeda M, Raman J, Gordon I, Buxton B. 1999. Comparative histopathology of radial artery versus internal thoracic artery and risk factors for development of intimal hyperplasia and atherosclerosis. Circulation 100:II-139-44.nSabik JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM. 2003. Does competitive flow reduce internal thoracic artery graft patency? Ann Thorac Surg 76:1490-7.nSakaguchi G, Tadamura E, Ohnaka M, Tambara K, Nishimura K, Komeda M. 2002. Composite arterial Y graft has less coronary flow reserve than independent grafts. Ann Thorac Surg 74:493-6.nSantos GG, Stolf NAG, Moreira LFP, et al. 2002. Randomized comparative study of radial artery and right gastroepiploic artery in composite arterial graft for CABG. Eur J Cardiothorac Surg 21:1009-14.nAl-Attar N. 2003. Coronary flow reserve in composite arterial Y grafts. Ann Thorac Surg 76:659-60.nCameron A, Kemp HG, Green GE. 1986. Bypass surgery with the internal mammary artery graft: 15 year follow-up. Circulation 74:III-30-6.nDenton TA, Trento L, Cohen M, et al. 2001. Radial artery harvesting for coronary bypass operations: neurologic complications and their potential mechanisms. J Thorac Cardiovasc Surg 121:951-6.nEndo M, Nishida H, Tomizawa Y, Kassnuki. 2001. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation 104:2164-70.nGenovesi MH, Robertazzi RR, Vitali RM, Connolly M, Subramanian VA. 2002. Recent progress in minimally invasive conduit harvesting. Semin Thorac Cardiovasc Surg 14:82-8.n



How to Cite

Yang, J.-H., Sung, K., Lee, Y. T., Park, K.-H., Jun, T.-G., & Park, P. W. (2005). Total Arterial Revascularization with a Single Y-Composite Graft for Triple-Vessel Disease: Comparison of 2- and 3-Artery Grafts. The Heart Surgery Forum, 7(5), E382-E386.




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