Total arterial revascularization with an internal thoracic artery and radial artery T graft

Background. Proximal anastomosis of the radial artery to the side of the internal thoracic artery (ITA) permits complete arterial revascularization in most patients, with the aim of improving long-term results of coronary artery bypass through greater long-term graft patency. The short-term results, however, have yet to be defined. We therefore reviewed our early experience with this grafting strategy. Methods. Between October 1, 1993, and September 1, 1998, 649 patients aged 30 to 85 years (mean, 60 ± 10 years) had primary coronary artery bypass using an ITA and radial artery in a T-graft configuration. Left ventricular function was severely depressed (ejection fraction <35%) in 12%, and left main stenosis was present in 14%. Results. A total of 937 distal anastomoses were performed with the left ITA (1.4 per patient) and 1,452 with the radial artery (2.2 per patient). There was one perioperative death (0.2%). There were 32 (5%) q-wave myocardial infarctions, and 14 patients (2%) had transient low output syndrome. There was one episode of hypoperfusion corrected by lengthening the left ITA. Angiography for clinical indications in 27 patients 1 to 35 months postoperatively (mean, 9.5 ± 8.3 months) demonstrated a distal anastomotic patency of 100% for ITA and 82% for radial artery grafts. Conclusions. Complete arterial revascularization can be achieved with an ITA and radial artery T-graft with low operative risk and acceptable early patency. These results support the continued investigation of this grafting strategy.