Myocardial Revascularization Using the Arterial T Graft: Which Conduit Should Be Chosen for the Free Graft?
DOI:
https://doi.org/10.1532/hsf.553Abstract
Background: The T graft is achieved by the end-to-side implantation of a free arterial graft into the left internal thoracic artery, which remains in situ. Which conduit is best suited as the free graft is still being discussed.
Methods: Two groups of patients are compared. The right internal thoracic artery (RITA) was used as a free graft in group I (n = 129), and the radial artery was used in group II (n = 84).
Results: The RITA was used more often with male patients (P < .02) and with patients presenting a reduced left ventricular ejection fraction (P < .03). The average number of coronary anastomoses per patient was higher in group II than in group I (P < .002). There were no significant differences between the groups in early mortality (0.8% in group I and 1.2% in group II) and morbidity. Postoperative chest tube output was significantly higher in group I than in group II (P < .05). The mean follow-up time was 35.2 ± 28.3 months. There were no significant differences regarding late mortality (6.9% in group I and 5.3% in group II) and the recurrence of angina (group I, 6 cases or 5.5%; group II, 3 cases or 4.2%). Because of the recurrence of angina or questionable chest pain in 22 patients, angiography was performed, and results showed a patency rate of 90.9% in group I and 93.1% in group II.
Conclusions: Based on our experience, we advise using the RITA as a free graft with tall men and also in patients with a reduced left ventricular ejection fraction, diabetes, and obesity. The radial artery should be used with small women if there is a high risk of bleeding and if several coronary anastomoses are necessary.
References
Calafiore AM, Di Giammarco G, Luciani N, Maddestra N, Di Nardo E, Angelini R. 1994. Composite arterial conduits for a wider arterial myocardial revascularization. Ann Thorac Surg 58:185-90.nEl Nakadi B, Choghari C, Joris M. 2000. Complete myocardial revascularization with bilateral internal thoracic artery T graft. Ann Thorac Surg 69:498-500.nIaco AL, Teodori G, Di Giammarco G, et al. 2001. Radial artery for myocardial revascularization: long-term clinical and angiographic results. Ann Thorac Surg 72:464-9.nLemma M, Gelpi G, Mangini A, et al. 2001. Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery. Ann Thorac Surg 71:1969-73.nPevni D, Kramer A, Paz Y, et al. 2001. Composite arterial grafting with double skeletonized internal thoracic arteries. Eur J Cardiothorac Surg 20:299-304.nRoyse AG, Royse CF, Shah P, Williams A, Kaushik S, Tatoulis J. 1999. Radial artery harvest technique, use and functional outcome. Eur J Cardiothorac Surg 15:186-93.nSundt TM 3rd, Barner HB, Camillo CJ, Gay WA Jr. 1999. Total arterial revascularization with an internal thoracic artery and radial artery T graft. Ann Thorac Surg 68:399-405.nTatoulis J, Buxton BF, Fuller JA, Royse AG. 1999. Total arterial coronary revascularization: techniques and results in 3,220 patients. Ann Thorac Surg 68:2093-9.nTector AJ, McDonald ML, Kress DC, Downey FX, Schmahl TM. 2001. Purely internal thoracic artery grafts: outcomes. Ann Thorac Surg 72:450-5.nUva MS, Braunberger E, Fisher M, et al. 1998. Does bilateral internal thoracic artery grafting increase surgical risk in diabetic patients? Ann Thorac Surg 66:2051-5.nWeinschelbaum EE, Gabe ED, Macchia A, Smimmo R, Suarez LD. 1997. Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg 114:911-6.n
