Right Y-graft, a new surgical technique using mammary arteries for total myocardial revascularization

Background. We report a new technique that consists of a right Y-graft usin g only skeletonized internal mammary arteries (IMA) for total arterial myoc ardial revascularization. Methods. This technique consists of anastomosing the in situ left IMA (LIMA ) and right IMA (RIMA) to the left anterior descending and obtuse marginal artery, via the transverse sinus, respectively. The distal free LIMA was an astomosed to the right coronary artery and afterwards in a Y fashion to the RIMA stem. Eleven patients with triple-vessel disease underwent coronary a rtery bypass grafting using this technique. Postoperatively and at follow-u p all patients underwent color Doppler contrast-enhanced transthoracic echo cardiography (TTE) before and after an adenosine provocation test. Results. Overall, 33 IMA-coronary anastomoses were made and II right Y-graf ts were constructed. At 1 week after operation color Doppler contrast-enhan ced TTE before and after the adenosine provocation test, respectively, show ed an increase in LIMA stem diameter of 0.31 mm and in mean flow 62 mL/min. Coronary now reserve (CFR) was 2 +/- 0.3. The increase in RIMA stem diamet er was 0.2 mm and in mean flow was 121.7 mL/min. Coronary flow reserve was 2.5 +/- 0.4. Only 1 patient demonstrated an anomalous Doppler pattern, sugg esting a partial Y-graft closure. Conclusions. Such a technique permits total myocardial revascularization us ing only mammary arteries and left ventricular perfusion from both IMAs sim ultaneously. The color Doppler contrast-enhanced TTE is a rapid, accurate, and noninvasive test allowing a good assessment of IMA patency. (Ann Thorac Surg 2000;70:820-3) (C) 2000 by The Society of Thoracic Surgeons.