title: Lambda graft with the radial artery or free left internal mammary artery anastomosed to the right internal mammary artery: flow dynamics.
abstract: BACKGROUND
  The aim of this study was to evaluate the outcome and flow dynamics of the lambda graft configuration, relative to a second arterial graft.
  
  
  METHODS
  From 1998 to 2000, 47 patients (mean age 55.5 +/- 4.7 years) with triple-vessel disease underwent arterial revascularization using the lambda graft. The in situ left internal mammary artery (LIMA) and right internal mammary artery (RIMA) were anastomosed to the left anterior descending (LAD) and obtuse marginal arteries, respectively. In 21 patients (group I) presenting proximal or middle-third LAD or right coronary (RC) arterial stenoses, the lambda graft was constructed by anastomosing the distal LIMA, as a free LIMA graft, to the RC and proximally to the in situ RIMA. In the other 26 patients (group II) presenting with middle-distal third LAD or RC arterial stenoses, the radial artery (RA) was used to construct the lambda graft. All patients underwent transthoracic echo color Doppler before and after an adenosine test at 1 week and 3 months after operation.
  
  
  RESULTS
  There were no hospital deaths. Overall, 47 lambda grafts were constructed. There was no difference between baseline and maximal flows and coronary flow reserve (CFR) between groups. CFR at IMA stems increased in both groups within 3 months versus 1 week [(LIMA)CFR = 2 +/- 0.3 vs 2.3 +/- 0.3 (p = 0.002) and (RIMA)CFR = 2.2 +/- 0.4 vs 2.5 +/- 0.3 (p = 0.009) in group I, and (LIMA)CFR = 2.12 +/- 0.33 vs 2.4 +/- 0.35 (p = 0.005) and (RIMA)CFR = 2.17 +/- 0.32 vs 2.52 +/- 0.26 (p = 0.001) in group II]. At 3 months versus 1 week, the (RIMA)diameter(i) (mm) at rest was 1.69 +/- 0.32 versus 1.48 +/- 0.2 (p = 0.015) in group I and 1.66 +/- 0.3 versus 1.47 + 0.2 (p = 0.01) in group II. At 6 +/- 2.4 months, all patients were free of angina.
  
  
  CONCLUSIONS
  These data, almost identical for free LIMA and RA to RIMA using the lambda graft, demonstrate that RIMA flow reserve is adequate for multiple coronary anastomoses irrespective of the second arterial graft.
authors.affiliation: Division of Cardiac Surgery, University of Carreggi, Firenze, Italy. edvinprifti@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Prifti
authors.forename: M
authors.initials: M
authors.lastname: Bonacchi
authors.forename: G
authors.initials: G
authors.lastname: Frati
authors.forename: P
authors.initials: P
authors.lastname: Proietti
authors.forename: G
authors.initials: G
authors.lastname: Giunti
authors.forename: M
authors.initials: M
authors.lastname: Leacche
mesh_terms: D001158:Arteries / Q000637:transplantation*; D001783:Blood Flow Velocity / Q000502:physiology; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*