The T graft is constructed by anastomosing the proximal end of the fre
e right internal thoracic artery to the side of the attached left inte
rnal thoracic artery. Besides adding considerable reach to the right i
nternal thoracic artery, this technique allows the left anterior desce
nding coronary artery and its branches to be bypassed with the attache
d left internal thoracic artery. Two hundred eighty-seven patients, ag
ed 34 to 86 years (mean age, 64.6 years) received an average of 4.4 in
ternal thoracic artery to coronary artery anastomoses. Sixty-nine pati
ents had left main disease, 33 were undergoing first-time reoperations
, and two were reoperated on for the second time. Ejection fraction ra
nged from 0.20 to 0.70. Operative mortality was 1.7%. Twenty-six patie
nts had postoperative graft visualization, and 94.7% of the grafts wer
e open. All 45 bypass grafts from the left infernal thoracic artery we
re patent, and 91% of those from the right internal thoracic artery we
re unobstructed. This procedure requires technical skill with internal
thoracic arteries, but it has the potential of significantly improvin
g long-term event-free survival and reducing the need for reoperation
in patients undergoing coronary artery bypass grafting.