Total Arterial Revascularization with a Single Y-Composite Graft for Triple-Vessel Disease: Comparison of 2- and 3-Artery Grafts

BACKGROUND: Treating triple-vessel disease by grafting a single Y-composite graft with 1 arterial conduit attached to the side of the internal thoracic artery is sometimes not used because of the possibility of hypoperfusion. METHODS: Between March 2001 and June 2003, 271 patients who underwent total arterial revascularization for triple-vessel disease were divided into 2 groups. Group I (n = 188) received a Y-composite graft with 2 arterial conduits, and group II (n = 83) received a Y-composite graft and 1 additional arterial conduit. We retrospectively reviewed the data and compared the clinical results of the 2 groups. RESULTS: The numbers of distal anastomoses were 3.9 +/- 0.7 (mean +/- SD) per patient in group I and 4.1 +/- 0.8 in group II (P = .021). There were 2 in-hospital deaths in group I and none in group II (difference not statistically significant). Perioperative myocardial infarction occurred in 2 patients in group I and none in group II (not statistically significant). No patient in either group needed a new intra-aortic balloon pump postoperatively, and no patients experienced hypoperfusion syndrome. A cerebrovascular accident occurred in 1 patient of each group. During the follow-up period (15.9 +/- 6.7 months in group I, 25.2 +/- 8.3 months in group II), 5 patients died (4 in group I, 1 in group II). Two patients in group I and 1 patient in group II needed an intervention on the right coronary artery, but the other patients required no additional procedures and had no symptoms of angina. There were no statistically significant differences in survival and reintervention-free survival between the 2 groups. CONCLUSION: Single Y-composite grafts with 2 arterial conduits may be a safe and effective strategy for treating triple-vessel disease.