Myocardial revascularization using the arterial T graft: which conduit should be chosen for the free graft?
BACKGROUND
The T graft is achieved by the end-to-side implantation of a free arterial graft into the left internal thoracic artery, which remains in situ. Which conduit is best suited as the free graft is still being discussed.


METHODS
Two groups of patients are compared. The right internal thoracic artery (RITA) was used as a free graft in group I (n = 129), and the radial artery was used in group II (n = 84).


RESULTS
The RITA was used more often with male patients (P < .02) and with patients presenting a reduced left ventricular ejection fraction (P < .03). The average number of coronary anastomoses per patient was higher in group II than in group I (P < .002). There were no significant differences between the groups in early mortality (0.8% in group I and 1.2% in group II) and morbidity. Postoperative chest tube output was significantly higher in group I than in group II (P < .05). The mean follow-up time was 35.2 +/-28.3 months. There were no significant differences regarding late mortality (6.9% in group I and 5.3% in group II) and the recurrence of angina (group I, 6 cases or 5.5%; group II, 3 cases or 4.2%). Because of the recurrence of angina or questionable chest pain in 22 patients, angiography was performed, and results showed a patency rate of 90.9% in group I and 93.1% in group II.


CONCLUSIONS
Based on our experience, we advise using the RITA as a free graft with tall men and also in patients with a reduced left ventricular ejection fraction, diabetes, and obesity. The radial artery should be used with small women if there is a high risk of bleeding and if several coronary anastomoses are necessary.
Vicol
Calin
C
Herzchirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, München, Germany. cvicol@belios.uni-muenchen.de
Raab
Stephan
S
Beyer
Michael
M
Reichart
Bruno
B
D001827:Body Height; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D009204:Myocardial Revascularization / Q000379:methods*; D017534:Radial Artery / Q000637:transplantation*; D015996:Survival Rate