Off-pump total arterial myocardial revascularization according to the right y-graft configuration

Objectives: The aims of this study were as follows: 1) to evaluate the early outcome of the off-pump total arterial myocardial revascularization according to the right y-graft (λ-graft) configuration and 2) to compare baseline flow and maximum flow between patients undergoing on-pump and off-pump right y-graft (RYG) construction. Methods: Between December 1998 and January 2001, 47 patients (Group I) and 20 patients (Group II) with three vessel disease underwent on-pump and off-pump coronary artery bypass graft (CABG) respectively according to the RYG configuration. The mean age was 55.5 ± 4.7 years and 55 ± 6.4 years in Groups I and II, respectively. The RYG was constructed employing both internal mammary arteries (IMAs) only, in 21 and 8 patients in Groups I and II, respectively, presenting proximal-middle third stenosis of the left anterior descending artery (LAD) and right coronary artery (RCA). The modified RYG configuration employing both IMAs and radial artery (RA) was performed in 26 and 12 patients in Groups I and II, respectively, presenting middle-distal third stenosis of the LAD and distal stenosis of the RCA or posterior descending artery stenosis. Postoperatively all patients underwent transthoracic echo color-Doppler (TTECD) contrast enhanced (by Levovist) before and after adenosine provocative testat one week and three months after operation. Results: There were no hospital deaths. The mean mechanical ventilation was significantly different in Group I versus Group II patients, 18 ± 4.4 hours versus 13 ± 5.7 hours, respectively (p = 0.041). The mean intensive care unit stay was 1.5 ± 0.6 days in Group I and 1 ± 0.4 days in Group II (p = 0.033). There were no differences between Groups I and II regarding the IMA diameter, mean velocity, and mean flow. At follow-up time, 6 ± 2.4 months after the surgical procedure, all patients were alive and free of angina. The coronary flow reserve (CFR) at LIMA main stem was significantly higher at three months when compared to the values at one week after the surgical procedure within the same group, ^LIMACFR (three months) = 2.37 ± 0.6 versus ^LIMACFR (one week) = 2.07 ± 0.4 (p = 0.005) in Group I and ^LIMACFR (three months) = 2.4 ± 0.4 versus ^LIMACFR (one week) = 2.06 ± 0.3 (p = 0.004) in Group II. Similarly, the CFR at RIMA main stem were significantly higher at three months when compared to the values at one week after the surgical procedure: ^RIMACFR (three months) = 2.47 ± 0.7 versus ^RIMACFR (one week) = 2.1 ± 0.5 (p = 0.004) in Group I and ^RIMACFR (three months) = 2.48 ± 0.5 versus ^RIMACFR (one week) = 2.08 ± 0.4 (p = 0.008) in Group II. Conclusion: The flow dynamic data, almost identical between patients undergoing off-pump and on-pump total arterial myocardial revascularization (TAMR) according to the RYG configuration, demonstrate that this technique can be applied with excellent results without the employment of cardiopulmonary bypass in selected coronary artery disease patients.