Revascularization of the left anterior descending artery area using a single left internal thoracic artery: auto-Y composite grafting or sequential bypassing.

Abstract

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. 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. 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). 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.