REIMPLANTATION OF THE RIGHT INTERNAL THORACIC ARTERY AS A FREE GRAFT INTO THE LEFT IN-SITU INTERNAL THORACIC ARTERY (Y-PROCEDURE) - ONE-YEAR ANGIOGRAPHIC RESULTS

Reimplantation of the right internal thoracic artery, as a free graft, into the left in situ internal thoracic artery (Y procedure) has enab led us to bypass more distant marginal vessels, which was not possible by the bilateral technique alone, This prospective study was aimed at evaluating the clinical state of the patients and the degree of paten cy of grabs within 16 months of follow-up, Ail 80 patients who underwe nt the Y procedure between January 1988 and January 1992 were included , This group represented 10% of the 840 patients having coronary bypas s during the same period, A total of 202 coronary anastomoses were per formed in this series, Early postoperative (30 days) complications inc luded three deaths (3.75%), eight myocardial infarctions (10%), one ca se of phrenic nerve paralysis (1.25%), two cases of respiratory failur e (2.5%), and six wound infections (7.5%), At 3 months' follow-up, 96% of patients were free of symptoms, During the follow-up period, four patients died of noncardiac causes (lung, pancreatic, and brain cancer and rupture of an abdominal aortic aneurysm), At 1 year, 71 patients were free of symptoms (97%), Sixty-one patients underwent coronary ang iography between 12 and 24 months, Six patients with peripheral arteri al disease were not suitable for coronary angiography, and six refused to be tested, These 12 patients had normal thallium test results in t he bypassed area (stress or dipyridamole test), The patency rate df th e left internal thoracic artery was 98.3% (n = 60), occlusion rate 1.6 % (n = 1), and incidence of threadlike arteries 4.9% (n = 3), Thus the rate of perfect patency nas 93.4%. The patency rate of the right inte rnal thoracic artery as a free graft was 93.4% (n = 57), occlusion rat e 6.5% (n = 4), and the incidence of threadlike arteries 8% (n = 5), T hus the rate of perfect patency was 85.2%, A total of 169 anastomoses were studied. The rate of patency of the anastomoses to the left anter ior descending coronary artery was 96% (n = 58) and the occlusion rate , 4% (n = 2), The patency rate of sequential anastomoses (side to side ) to diagonal arteries was 100% (n = 16), Patency rate of anastomoses to obtuse marginal arteries was 95% (n = 58) and the rate of occlusion , 4.9% (n = 3), The patency rate of anastomoses to the posterior desce nding artery or distal branches of the right coronary artery was 80% ( n = 4/5), We conclude that the Y procedure is a safe technique with an acceptable morbidity and a good patency rate, This procedure can be u sed when the in situ technique is not possible because of Par-reaching distal marginal coronary arteries.