lambda graft with the radial artery or free left internal mammary artery anastomosed to the right internal mammary artery: Flow dynamics

Background. The aim of this study was to evaluate the outcome and flow dyna mics of the A graft configuration, relative to a second arterial graft. Methods. From 1998 to 2000, 47 patients (mean age 55.5 +/- 4.7 years) with triple-vessel disease underwent arterial revascularization using the A graf t. The in situ left internal mammary artery (LIMA) and right internal mamma ry artery (RIMA) were anastomosed to the left anterior descending (LAD) and obtuse marginal arteries, respectively. In 21 patients (group I) presentin g proximal or middle-third LAD or right coronary (RC) arterial stenoses, th e A graft was constructed by anastomosing the distal LIMA, as a free LIMA g raft, to the RC and proximally to the in situ RIMA. In the other 26 patient s (group II) presenting with middle-distal third LAD or RC arterial stenose s, the radial artery (RA) was used to construct the A graft. All patients u nderwent transthoracic echo color Doppler before and after an adenosine tes t at 1 week and 3 months after operation. Results. There were no hospital deaths. Overall, 47 A grafts were construct ed. There was no difference between baseline and maximal flows and coronary flow reserve (CFR) between groups. CFR at IMA stems increased in both grou ps within 3 months versus 1 week [(CFR)-C-LIMA = 2 +/- 0.3 vs 2.3 +/- 0.3 ( p = 0.002) and (CFR)-C-RIMA = 2.2 +/- 0.4 vs 2.5 +/- 0.3 (p = 0.009) in gro up I, and (CFR)-C-LIMA = 2.12 +/- 0.33 vs 2.4 +/- 0.35 (p = 0.005) and (CFR )-C-RIMA = 2.17 +/- 0.32 vs 2.52 +/- 0.26 (p = 0.001) in group II]. At 3 mo nths versus 1 week, the (RIMA)diameter(i) (mm) at rest was 1.69 +/- 0.32 ve rsus 1.48 +/- 0.2 (p = 0.015) in group I and 1.66 +/- 0.3 versus 1.47 +/- 0 .2 (p = 0.01) in group II. At 6 +/- 2.4 months, all patients were free of a ngina. Conclusions. These data, almost identical for free LIMA and RA to RIMA usin g the A graft, demonstrate that RIMA flow reserve is adequate for multiple coronary anastomoses irrespective of the second arterial graft. (C) 2001 by The Society of Thoracic Surgeons.