Right Y-graft, a new surgical technique using mammary arteries for total myocardial revascularization

Bonacchi, Massimo; Prifti, Edvin; Giunti, Guido; Salica, Andrea

doi:10.1016/s0003-4975(00)01500-9

Cited by 24 publications

(30 citation statements)

References 18 publications

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“…Now days the free Right Internal Mammary Artery (RIMA) is preferred instead of the venous graft. This kind of tailored graft with the use of a free RIMA as a bridge from LIMA and a branch of Left Circumflex Artery (LCx) has been developed after observing that arterial conduits had a better outcome in terms of patency [1]. The global graft structure is therefore formed by the LIMA connected to the Left Anterior Descending Artery (LAD) and by a free RIMA connected to the Obtuse Marginal Artery of LCx (Fig.…”

Section: Introductionmentioning

confidence: 99%

Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

Auriti

Loiaconi

Pristipino

et al. 2010

Cardiovasc Ultrasound

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BackgroundY- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR).MethodsIn 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test ≥2 was considered normal CFR.ResultsCoronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 ± 0.5 to 2.6 ± 0.5, p = 0.03) and in LCx (1.7 ± 1 to 2.12 ± 1, p = 0.05). CFR was under normal at baseline in 30% of patients vs 8% after six months in LAD (p = 0.027), and in 69% of patients vs 30% after six months in LCx (p = 0.066).ConclusionCFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.

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Section: Introductionmentioning

confidence: 99%

Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

Auriti

Loiaconi

Pristipino

et al. 2010

Cardiovasc Ultrasound

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“…The STO/RTO ratio, that is the coronary flow reserve, has been considered by several authors as the best manner to evaluate if the graft is capable of offering an adequate blood flow in situations of increased demand [8,13,14]. In this study, the STO/RTO ratio in the anastomosed LITA graft was 1.60 in group A, while in group B it was 1.89.…”

Section: Commentsmentioning

confidence: 79%

Revascularização miocárdica com enxerto composto de artéria torácica interna esquerda em Y: análise de fluxo sangüíneo

Filho¹,

Leitão²,

Filho³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To assess the left internal thoracic artery (LITA) flow pattern, when it was used to supply the left anterior descending artery (LADA) and another branch from the left coronary artery system (LCAS).Methods: In the following study, the left internal thoracic artery flow was investigated by echocardiography Doppler, at rest and under dobutamine stress, in two twenty-patient groups. Group A consisted of patients who received only a pedicled LITA graft to the LADA. Group B consisted of patients who received a pedicled LITA graft associated with a vein graft to supply the LADA and another artery from the LCAS. The angiographic study showed graft patency in all patients from both groups. The following parameters were used: systolic flow (SF), diastolic flow, total flow, total flow in stress/ total flow at rest ratio (TFS/TFR), systolic peak velocities (SPV), diastolic peak velocities and systolic peak velocity/ diastolic peak velocity ratio.Results: All analyzed parameters were considered statistically significant, except SF, TFS/TFR and SPV.Conclusions: We concluded that in the same conditions and methodology, the LITA flow in the composite graft (group B) is higher than in the free graft (group A), which shows the great flow adaptability of the LITA to respond to flow demand.

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“…A ATIE, como única fonte de suprimento sangüíneo para mais de uma coronária, de forma seqüencial, em "Y" ou em "T", utilizando enxerto de safena ou de artéria radial, é descrito na literatura, sobretudo para revascularizar pacientes com alto risco para AVC, com bons resultados (7,(27)(28)(29) . QUIGLEY et al (30) demonstraram a reprodutibilidade desse procedimento, utilizando enxertos arteriais, quando realizado sem CEC.…”

Section: Resultsunclassified

Cirurgia de revascularização coronariana esquerda sem CEC e sem manuseio da aorta em pacientes acima de 75 anos: análise das mortalidades imediata e a médio prazo e das complicações neurológicas no pós-operatório imediato

Filho¹,

Leitão²,

Filho³

et al. 2002

Rev Bras Cir Cardiovasc

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ResumoIntrodução: A circulação extracorpórea (CEC) e o manuseio da aorta ascendente (MAA) estão associados a alta incidência de acidente vascular cerebral (AVC) na cirurgia de revascularização do miocárdio (RM) em pacientes idosos. Esta complicação deve-se, sobretudo, ao MAA, por ocasião do pinçamento e despinçamento, quer para isolamento do coração do circuito de CEC, quer para realização das anastomoses dos enxertos na aorta ascendente.Objetivos: Verificar mortalidades imediata e a médio prazo e a ocorrência de AVC no pós-operatório imediato (POI) em pacientes acima de 75 anos submetidos a cirurgia de revascularização do sistema coronariano esquerdo (SCE), sem CEC e sem MAA.Método Análise das mortalidades imediata e a médio prazo e das complicações neurológicas no pós-operatório imediato

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Right Y-graft, a new surgical technique using mammary arteries for total myocardial revascularization

Cited by 24 publications

References 18 publications

Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

Revascularização miocárdica com enxerto composto de artéria torácica interna esquerda em Y: análise de fluxo sangüíneo

Cirurgia de revascularização coronariana esquerda sem CEC e sem manuseio da aorta em pacientes acima de 75 anos: análise das mortalidades imediata e a médio prazo e das complicações neurológicas no pós-operatório imediato

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