title: Revascularization of the left anterior descending artery area using a single left internal thoracic artery: auto-Y composite grafting or sequential bypassing.
abstract: OBJECTIVE
  To maximize the use of left internal thoracic artery in coronary artery bypass grafting, we have adopted a strategy to revascularize the left anterior descending artery area using a single skeletonized left internal thoracic artery; auto-Y composite grafting and sequential bypassing. This study evaluated graft patency and clinical outcomes after these procedures.
  
  
  METHODS
  Between 2003 and 2009, 144 patients (112 men; age, 62.9 ± 8.9 years) underwent coronary artery bypass grafting using a single left internal thoracic artery graft to bypass the left anterior descending artery and a diagonal branch. Of them, 57 patients underwent sequential anastomosis (sequential group), and 87 underwent auto-Y composite anastomosis (auto-Y group). Graft patency was assessed using serial multidetector computed tomography.
  
  
  RESULTS
  There were no early mortalities. During a mean follow-up duration of 66.2 ± 44.5 months, there were 8 deaths, including 2 cardiac deaths, and no cases of reintervention. The 2 groups were at similar risks of death on crude and adjusted analyses (P = .109 and .216). The 2-year patency rates for the LAD site were 98% in the sequential group and 100% in the auto-Y group (P = .195). The 2-year patency rates for the diagonal artery site were 100% in the sequential group and 92.9% in the auto-Y group (P = .038).
  
  
  CONCLUSIONS
  Revascularization of the left anterior descending artery area using a single skeletonized left internal thoracic artery resulted in excellent clinical outcomes and graft patency using either auto-Y or sequential grafting. However, there was a higher rate of diagonal branch graft occlusion after auto-Y compared with sequential grafting.
authors.affiliation: Department of Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Songpa-gu, Seoul, Korea.
authors.forename: Won-Chul
authors.initials: WC
authors.lastname: Cho
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency