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From May 1989 to December 1995, 143 patients underwent myocardial revascularization with one (138 patients) or two (five patients) coronary-coronary bypass grafts in addition to other bypass grafts, for a total of 463 distal anastomoses (mean 3.2 +/- 0.6 per patient). Coronary-coronary bypass grafts were chosen for the following reasons: arterial conduit-sparing procedure, inadequate length for in situ graft, calcified ascending aorta, and stenosed or occluded subclavian arteries. One hundred eleven arterial grafts (75%) were used: 85 right internal thoracic arteries, 18 left internal thoracic arteries, and eight radial arteries. Saphenous vein grafts were used in 37 cases (25%, mostly in our early experience). Coronary-coronary bypass grafts were performed on the right coronary artery in 134 cases (90.5%), on the circumflex artery in five cases (3.3%), on the left anterior descending coronary artery in four cases (2.7%), and between two different coronary arteries in five cases (3.3%). Three patients (2%) died of myocardial infarction. Early postoperative angiography showed a patency rate of 98.6% (72/73). During the mean follow-up of 34.6 +/- 20.8 months, two patients died and two underwent reoperation. Results of exercise testing were normal at 2 months in 97% of patients (90/92), at 1 year in 96% (81/84), and at 3 years in 93% (30/32). In conclusion, the coronary-coronary bypass graft provides good results with a variety of conduits and allows the expanded use of arterial grafts, particularly the internal thoracic artery. This can lead to a sparing of arterial conduit and allow complex myocardial revascularization with a liberal use of internal thoracic arteries.

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Conclusions: The natural progression of cAAA is not well-defined, but it has shown to have a high risk of rupture and mortality in young children. Early diagnosis and repair of cAAA are crucial in preventing rupture, and in this case early elective open repair with tubular ePTFE graft was safe and effective. It is important to choose a vascular conduit with the diameter and length to accommodate children's vascular developmental process. More investigation should be undertaken for the natural history of cAAA, new-generation allograft in its repair, and its optimal surveillance timing and method.

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