Odayan M K, Paterson H S
Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia.
Ann Thorac Surg. 1999 May;67(5):1359-61. doi: 10.1016/s0003-4975(99)00185-x.
The proved long-term patency of the left internal thoracic artery (LITA) has made it the conduit of choice for myocardial revascularization. Maximal utilizable LITA length can be achieved by using a semiskeletonizing harvest technique. Expanded LITA use with sequential and Y graft techniques allows for a wider territory of myocardial revascularization.
A retrospective analysis of 30 patients undergoing coronary artery bypass surgery with a LITA-Y graft between December 1994 and November 1996 was performed. In selected patients the LITA was cut to length and anastomosed to the left anterior descending artery (LAD), with the redundant length of LITA used as a free graft to the lateral circumflex and diagonal systems. The proximal end of the free LITA was anastomosed to the in situ LITA to form the Y graft. Selection criteria included: a) minimal distal disease in the LAD and circumflex systems; and b) graftable circumflex branches proximal to the mid free wall of the left ventricle, allowing total revascularization of the left coronary system with the Y graft.
Thirty patients (22 male, 8 female) underwent the LITA-Y graft procedure. There were no deaths or episodes of myocardial infarction. One patient required inotropic and intraaortic balloon pump support. Two patients with isolated coronary ostial stenosis developed recurrence of angina due to occlusion of the free limb of the LITA.
In patients with suitable coronary artery anatomy, the LITA-Y graft can be successfully performed with good short-term outcome, but may be contraindicated in the management of isolated coronary ostial stenosis.
已证实左乳内动脉（LITA）具有长期通畅性，这使其成为心肌血运重建的首选血管桥。采用半骨骼化获取技术可实现LITA的最大可用长度。通过序贯和Y形移植技术扩大LITA的应用范围，可实现更广泛区域的心肌血运重建。
对1994年12月至1996年11月期间接受LITA - Y形移植冠状动脉搭桥手术的30例患者进行回顾性分析。在选定患者中，将LITA裁剪至合适长度并与左前降支动脉（LAD）吻合，LITA多余的长度作为游离移植物用于旋支和对角支系统。游离LITA的近端与原位LITA吻合形成Y形移植物。选择标准包括：a）LAD和旋支系统远端病变轻微；b）左心室游离壁中部近端有可移植的旋支分支，以便通过Y形移植物实现左冠状动脉系统的完全血运重建。
30例患者（22例男性，8例女性）接受了LITA - Y形移植手术。无死亡病例或心肌梗死发作。1例患者需要使用正性肌力药物和主动脉内球囊泵支持。2例孤立性冠状动脉开口狭窄患者因LITA游离支闭塞出现心绞痛复发。
在冠状动脉解剖结构合适的患者中，LITA - Y形移植手术可成功实施且短期效果良好，但在孤立性冠状动脉开口狭窄的治疗中可能为禁忌。
