title: Early results of complete off-pump coronary revascularization using left internal thoracic artery with composite radial artery.
abstract: OBJECTIVE
  Off-pump coronary artery bypass (OPCAB) using the left internal thoracic artery (LITA) with a composite radial artery (RA) was employed for arterial revascularization in order to minimize neurological complication.
  
  
  METHODS
  Sixty-one patients underwent OPCAB using the LITA with a composite RA. Angiography was performed in all patients at two weeks postoperatively.
  
  
  RESULTS
  The mean number of distal anastomoses was 3.2 +/- 0.4. A Y-composite graft was used in 55 patients, and K-composite graft was used in the other 6 patients. There was no hospital death, no neurological complication nor deep sternal infection. Furthermore, there was no episode of perioperative myocardial infarction nor hypoperfusion syndrome. Patients have been angina-free during a mean follow-up period of 1 year. The graft patency of the LITA to the left anterior descending artery (LAD) was 100% (61/61 anastomoses). The RA became occluded in 4 patients, and the patency rate was 95.6% (130/136 anastomoses). String or coronary-coronary bypass resulting from flow competition was observed in the LITA of 6 patients and in the RA of 13 patients. The string of the LITA occurred in the segment distal from the anastomosis with the composite RA. The string or coronary-coronary bypass was observed more often in cases in which the recipient coronary artery had less than 75% stenosis.
  
  
  CONCLUSIONS
  OPCAB using only the LITA with a composite RA can be successfully and safely performed in patients with multivessel disease. Late postoperative follow-up of the flow competition is necessary to delineate the significance of flow competition.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Tagusari
authors.forename: Ko
authors.initials: K
authors.lastname: Bando
authors.forename: Kazuo
authors.initials: K
authors.lastname: Niwaya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Michiko
authors.initials: M
authors.lastname: Ishida
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D017534:Radial Artery / Q000637:transplantation*; D016896:Treatment Outcome; D014654:Vascular Patency