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 -graft using only skeletonized internal mammary arteries (IMA) for total arterial myocardial 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 anastomosed to the right coronary artery and afterwards in a fashion to the RIMA stem. Eleven patients with triple-vessel disease underwent coronary artery bypass grafting using this technique. Postoperatively and at follow-up all patients underwent color Doppler contrast-enhanced transthoracic echocardiography (TTE) before and after an adenosine provocation test. Results. Overall, 33 IMA-coronary anastomoses were made and 11 right -grafts were constructed. At 1 week after operation color Doppler contrast-enhanced TTE before and after the adenosine provocation test, respectively, showed an increase in LIMA stem diameter of 0.31 mm and in mean flow 62 mL/min. Coronary flow reserve (CFR) was 2 ± 0.3. The increase in RIMA stem diameter 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, suggesting a partial -graft closure. Conclusions. Such a technique permits total myocardial revascularization using only mammary arteries and left ventricular perfusion from both IMAs simultaneously. The color Doppler contrast-enhanced TTE is a rapid, accurate, and noninvasive test allowing a good assessment of IMA patency.