title: Complete Revascularization of the Three-Vessel Territories Using a Left Internal Thoracic Artery Composite Graft.
abstract: BACKGROUND
  We evaluated whether revascularization using a Y-composite graft based on the left internal thoracic artery (ITA) is sufficient for patients with 3-vessel disease.
  
  
  METHODS
  Of 542 patients who underwent complete revascularization for 3-vessel disease, patients who received either single inflow from a left ITA-based Y-composite graft (group S, n = 297) or who received multiple inflows (including bilateral in situ ITAs, in situ right gastroepiploic artery, or aortocoronary grafts) (group M, n = 245) were compared. Clinical outcomes and myocardial perfusion improvement during the first postoperative year were studied. Baseline differences between groups were adjusted by inverse probability of treatment weighting (IPTW). Median follow-up duration was 94 (2 to 176) months.
  
  
  RESULTS
  There were no differences in early mortality (4 of 297 vs 4 of 245; p > 0.999) and morbidity rates between the 2 groups, except atrial fibrillation (which was higher in group S than in group M; p < 0.001). There were no differences between the 2 groups in IPTW-adjusted overall survival, freedom from cardiac death, and freedom from major adverse cardiac and cerebrovascular events at 5 and 10 years (group S, 85.2% and 76.2% vs group M, 88.6% and 74.1%, p = 0.990). The IPTW-adjusted Cox proportional hazard model demonstrated that age (p = 0.030) and aortocoronary saphenous vein grafting (p = 0.002) were risk factors for major adverse cardiac and cerebrovascular events. Myocardial single photon emission computed tomography performed preoperatively, and 3 months and 1 year postoperatively demonstrated similar patterns of myocardial perfusion improvement between the 2 groups (p = 0.483).
  
  
  CONCLUSIONS
  Revascularization using a Y-composite graft based on the left ITA for single inflow was sufficient for patients with 3-vessel disease in terms of early and long-term clinical outcomes and myocardial perfusion improvement.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Hwang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hong Chul
authors.initials: HC
authors.lastname: Oh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kimkb@snu.ac.kr.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Kim
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D012189:Retrospective Studies