A simple modification for a longer and larger internal thoracic artery as a composite Y-graft

Figures & data

Figure 1. Coronary angiography showing near total occlusion of the left anterior descending artery. The length of the occlusion involves a long segment of the middle portion of the artery (asterisk). The suitable bypass area is fairly distal (white arrow).

Table I. Patient characteristics.

Variable	Group L n = 30	Group R n = 18	Overall n = 48	p value
Male	26 (87%)	14 (78%)	40 (83%)	0.424
Mean age (SD)	56 (6.64)	61 (7.93)	58 (7.62)	0.009
Diabetes mellitus	10 (33%)	10 (56%)	20 (42%)	0.131
Hypertension	15 (50%)	10 (56%)	25 (52%)	0.709
Chronic renal failure	0 (0%)	2 (11%)	2 (4%)	0.062
History of stroke	3 (10%)	2 (11%)	5 (10%)	0.903
Atrial fibrillation	2 (7%)	1 (6%)	3 (6%)	0.878
History of PCI	3 (10%)	3 (17%)	6 (13%)	0.499
Mean EF (%)	52 (9.96)	51 (11.97)	52 (10.61)	0.813
Left main disease	16 (53%)	11 (61%)	27 (56%)	0.599
Triple vessel disease	22 (73%)	16 (89%)	38 (79%)	0.199

SD: standard deviation; PCI: percutaneous coronary intervention; EF: ejection fraction.

Table II. Operative and postoperative outcomes.

Variable	Group L	Group R	Overall	p value
CPB time (SD)	121 (50.97)	140 (49.89)	125 (50.23)	0.554
ACC time (SD)	77 (35.77)	91 (39.39)	82 (37.35)	0.224
Number of distal anastomoses	3.2 (0.77)	3.4 (0.78)	3.3 (0.77)	0.367
Follow-up angiography	21 (70%)	14 (77.8%)	35 (72.9%)	0.557
Months between surgery and follow-up angiography (SD)	13 (16.8)	7 (13.1)	10 (15.5)	0.279
ITA graft failure	2 (6.7%)	0	2 (4.2%)	0.234
New cardiovascular event	2 (6.7%)	3 (16.7%)	5 (10.4%)	0.272

CPB: cardiopulmonary bypass; SD: standard deviation; ACC: aorta cross clamp time; ITA: internal thoracic artery.

Figure 2. A composite Y-graft using the BITA: The RITA is long enough to reach the distal left anterior descending artery (A). The diameter of the RITA is larger than that of the LITA because the end of the RITA is usually within two-thirds of the entire RITA (B).The more proximal and larger portion of the RITA can be used for the left anterior descending artery rather than the LITA.