title: Y grafts with the left internal mammary artery and radial artery. Mid-term functional and angiographic results. Cohort study.
abstract: BACKGROUND
  This retrospective cohort study investigated the functional and haemodynamic mid-term results over 3-years follow up of the left internal mammary artery (LIMA) conduit in composite Y-graft configuration with radial artery (RA) in a population of patients who underwent off-pump coronary artery bypass grafting (CABG).
  
  
  METHODS
  148 patients who underwent off-pump CABG with composite Y-graft, were evaluated over 3-year follow up. Two-day dipyridamole induced maximal hyperaemia/rest 99mTc-sestamibi was scheduled preoperatively and 36 months after surgery for functional evaluation. Morphological evaluation was performed by 64 slice multidetector computed tomography (CT) 36 months after surgery.
  
  
  RESULTS
  Clinical adverse events were rare within 3 years follow up. Minimal to severe scintigraphic evidence of stress induced ischaemia occurred in 24 patients. Left ventricular (LV) hypertrophy (HR 3.1; 95% CI, 1.5-9.3; p = 0.01) and poor coronary run off (HR 4.1; 95% CI, 2.1-10.8; p = 0.005) were significant multivariate predictors of reversible stress induced ischaemia. 64 slice multidetector CT showed that the main stem of Y composite grafts was patent in all patients, while distal LIMA or RA was stenosed or occluded in 9 patients.
  
  
  CONCLUSIONS
  Composite Y-graft was adequate to meet the flow requirements of target coronary artery either at rest or during maximal hyperaemia. The use of Y-graft should be carefully evaluated in patients with LV hypertrophy and/or poor coronary run-off.
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy. Electronic address: vitomannacio2@libero.it.
authors: Vito
authors: V
authors: Mannacio
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy.
authors: Anna
authors: A
authors: De Vita
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy; Department of Cardiology, Azienda Ospedaliera Santobono-Pausillipon, Naples, Italy.
authors: Anita
authors: A
authors: Antignano
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy.
authors: Michele
authors: M
authors: Mottola
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy.
authors: Luigi
authors: L
authors: Di Tommaso
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy.
authors: Ascanio
authors: A
authors: Graniero
authors: Department of Cardiac Surgery, University Federico II, School of Medicine, Naples, Italy.
authors: Carlo
authors: C
authors: Vosa
mesh_terms: D000368:Aged; D000792:Angiography; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump; D003326:Coronary Circulation; D004176:Dipyridamole; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D013997:Time Factors; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole
keywords: 99mTc-sestamibi SPECT; CABG; Composite Y-grafts; Multi-slice computed tomography