TOTAL REVASCULARIZATION WITH T-GRAFTS

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.