Myocardial revascularization with modified T-graft using bilateral internal thoracic arteries.
OBJECTIVE
By using a T-graft configuration, the myocardium may be completely revascularized with bilateral internal thoracic arteries. This study aimed to evaluate the perioperative morbidity and mortality in a single surgeon's early experience with a modified T-graft using bilateral internal thoracic arteries.


METHODS
Between October 1994 to April 1997, 200 consecutive patients mostly selected per protocol, received a T-graft with bilateral internal thoracic arteries for stable angina pectoris (n = 157) or unstable angina pectoris (n = 43). The mean age of patients was 56 years (range of 36 to 78 years). There were 171 males and 29 females. Forty-three patients had diabetes. Concomitant procedures were performed in 8 patients.


RESULTS
In 190 patients (95%), total arterial revascularization of the myocardium was achieved solely by the use of bilateral internal thoracic arteries in a T-graft configuration and the number of anastomoses per patient averaged 4.2. Ten patients (5%) received supplemental saphenous veins in addition to T-grafts for low cardiac output (n = 3), intraoperative regional ischaemia (n = 2), postoperative myocardial ischaemia (n = 2) and inadequate conduits (n = 3). The 30-day mortality was 0.5%. Perioperative myocardial infarct occurred in 2 patients (1.0%). Reasons encountered for early re-operation included bleeding (n = 7), sternal dehiscence (n = 5), suppurative sternitis (n = 3) and myocardial ischaemia (n = 2). Twelve patients received inotropes and intraaortic balloon counterpulsation was employed in 3 patients.


CONCLUSIONS
When bilateral internal thoracic arteries were used in a T-graft configuration, total arterial revascularization of the myocardium was achieved with an acceptably low morbidity and mortality.
Lai
D T
DT
Department of Cardiothoracic Surgery, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia.
Paterson
H S
HS
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000787:Angina Pectoris / Q000601:surgery; D000789:Angina, Unstable / Q000601:surgery; D002303:Cardiac Output, Low / Q000601:surgery; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D013249:Sternum / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery; D015996:Survival Rate; D013895:Thoracic Arteries / Q000637:transplantation*
D002316:Cardiotonic Agents