Rahman M H, Howlader S S, Chanda P K, Ahmed F, Rahman A K
Dr Mohammad Hafizur Rahman, Associate Professor & Consultant, Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute (NHFH&RI), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2020 Oct;29(4):939-944.
The Left internal mammary artery (LIMA) is considered the conduit of choice for the surgical treatment (CABG, coronary artery bypass grafting) of Coronary artery disease (CAD) due to its superior long term potency than the other conduits. Sequential anastomosis with the LIMA in CABG increases the number of arterial graft and more completeness the arterial revascularization. To increase the number of arterial graft and improved long term potency, an alternative technique is sequential anastomosis of LIMA to Diagonal (D) & left anterior descending artery (LAD) and LIMA-LIMA "Y" Graft play a vital role in patients with tight proximal lesion. Perioperative data were prospectively collected from all patients with isolated CAD with tight proximal LAD lesion, who underwent off-pump CABG from November 2013 to October 2015 at a single Centre. A total of 321 patients had LIMA to D & LAD sequential and LIMA-LIMA "Y" grafts pattern with severe proximal LAD lesion. The mean age was 54.7±8.4 years, male & female ratio was 29.7:7.5. Left main involvement was in 25% & triple vessel disease was 89% with LVEF 53.6±8.6%. Sequential LIMA to diagonal (side to side) & LAD (end to side) done in all 294 cases and LIMA-LIMA"Y" grafts in 27 cases. Thirty days mortality was 0.935% (3 patients). Postoperative myocardial infarction (MI) occurred in 2 patients (0.623%). Two sequential LIMA graft failed and both the diagonal & LAD bypassed coronary arteries were very narrow, about 1mm in diameter. All the patients underwent postoperative NYHA class evaluation at 3-6 months follow up & found normal and none of the patients suffered for angina. Revascularization with skeletonized sequential LIMA anastomosis to D, LAD & LIMA-LIMA "Y" graft is a safe, feasible with improve overall long-term potency and reproducible alternative in the presence of severe proximal LAD lesion to the complete revascularization of the anterior& lateral myocardial wall. Long term follow-up with coronary angiogram is essential to recommend this technique as standard one.
由于左乳内动脉（LIMA）相较于其他血管移植物具有更优越的长期功能，因此它被认为是冠状动脉疾病（CAD）外科治疗（冠状动脉旁路移植术，CABG）的首选血管移植物。在CABG中，LIMA的序贯吻合增加了动脉移植物的数量，并使动脉血运重建更加完全。为了增加动脉移植物的数量并改善长期功能，一种替代技术是将LIMA与对角支（D）和左前降支动脉（LAD）进行序贯吻合，而LIMA-LIMA“Y”型移植物在近端病变严重的患者中起着至关重要的作用。前瞻性收集了2013年11月至2015年10月在单一中心接受非体外循环CABG的所有孤立性CAD且近端LAD病变严重的患者的围手术期数据。共有321例患者采用了LIMA与D和LAD的序贯以及LIMA-LIMA“Y”型移植物模式，伴有严重的近端LAD病变。平均年龄为54.7±8.4岁，男女比例为29.7:7.5。左主干受累占25%，三支血管病变占89%，左心室射血分数（LVEF）为53.6±8.6%。所有294例患者均进行了LIMA与对角支（侧侧）和LAD（端侧）的序贯吻合，27例患者进行了LIMA-LIMA“Y”型移植物吻合。30天死亡率为0.935%（3例患者）。术后心肌梗死（MI）发生在2例患者（0.623%）。两根序贯LIMA移植物失败，对角支和LAD旁路的冠状动脉均非常狭窄，直径约为1mm。所有患者在术后3 - 6个月随访时进行了纽约心脏协会（NYHA）心功能分级评估，结果正常，且无一例患者患有心绞痛。在存在严重近端LAD病变的情况下，采用骨骼化LIMA与D、LAD序贯吻合及LIMA-LIMA“Y”型移植物进行血运重建是一种安全、可行的方法，可改善整体长期功能，并且是使前壁和侧壁心肌完全血运重建的可重复替代方法。进行冠状动脉造影的长期随访对于将该技术推荐为标准技术至关重要。
