T grafts with the right internal thoracic artery to left internal thoracic artery versus the left internal thoracic artery and radial artery: Flow dynamics in the internal thoracic artery main stem

Abstract

Objective: Complete arterial coronary artery bypass grafting with 2 grafts can be achieved even in triple vessel disease by use of a T configuration. There is still uncertainty whether the coronary flow reserve in the main stem of the left internal thoracic artery is sufficient to supply more than 1 anastomosed coronary vessel. Methods: Between March 1996 and February 1999, 251 patients with multivessel coronary artery disease underwent complete arterial revascularization with T grafts, using either the left internal thoracic artery with the free right internal thoracic artery graft (n = 73, group I) or the left internal thoracic artery and radial artery (n = 178, group II). A mean of 4.0 (group I) versus 4.3 (group II) coronary vessels were anastomosed per patient. One week (n = 92) and 6 months (n = 28) after the operation, flow was measured in the proximal left internal thoracic artery with a Doppler guide wire. Maximum flow was determined after injection of adenosine (30 μg). Results: The in-hospital mortality was 2.7% (group I) versus 2.3% (group II). At angiography (n = 142, 56.6%) the patency rate was 96.3% (group I) versus 98.2% (group II). There was no significant difference between baseline flow, maximum flow, and coronary flow reserve between the 2 groups. Coronary flow reserve increased in both groups within the first 6 postoperative months (group I, 1.85 ± 0.31 vs 2.77 ± 0.77, P = .0002; group II, 1.82 ± 0.4 vs 2.53 ± 0.73, P = .009). Conclusion: Both variants of T grafts allow for complete arterial revascularization with good perioperative results. The flow reserve of the proximal internal thoracic artery is adequate for multiple coronary anastomoses irrespective of the choice of the second arterial graft. (J Thorac Cardiovasc Surg 1999;118:841-8)