Tector A J, Amundsen S, Schmahl T M, Kress D C, Peter M
Midwest Heart Surgery Institute, Milwaukee, Wisconsin.
Ann Thorac Surg. 1994 Jan;57(1):33-8; discussion 39. doi: 10.1016/0003-4975(94)90361-1.
The T graft is constructed by anastomosing the proximal end of the free right internal thoracic artery to the side of the attached left internal thoracic artery. Besides adding considerable reach to the right internal thoracic artery, this technique allows the left anterior descending coronary artery and its branches to be bypassed with the attached left internal thoracic artery. Two hundred eight-seven patients, aged 34 to 86 years (mean age, 64.6 years) received an average of 4.4 internal thoracic artery to coronary artery anastomoses. Sixty-nine patients had left main disease, 33 were undergoing first-time reoperations, and two were reoperated on for the second time. Ejection fraction ranged from 0.20 to 0.70. Operative mortality was 1.7%. Twenty-six patients had postoperative graft visualization, and 94.7% of the grafts were open. All 45 bypass grafts from the left internal thoracic artery were patent, and 91% of those from the right internal thoracic artery were unobstructed. This procedure requires technical skill with internal thoracic arteries, but it has the potential of significantly improving long-term event-free survival and reducing the need for reoperation in patients undergoing coronary artery bypass grafting.
T形移植物是通过将游离的右胸廓内动脉近端与附着的左胸廓内动脉侧面进行吻合构建而成。除了显著增加右胸廓内动脉的长度外，该技术还能使附着的左胸廓内动脉绕过左前降支冠状动脉及其分支。287例年龄在34至86岁（平均年龄64.6岁）的患者平均接受了4.4次胸廓内动脉至冠状动脉的吻合。69例患者患有左主干病变，33例正在进行首次再次手术，2例进行了第二次再次手术。射血分数范围为0.20至0.70。手术死亡率为1.7%。26例患者术后移植物显影，94.7%的移植物通畅。来自左胸廓内动脉的45条旁路移植物均通畅，来自右胸廓内动脉的移植物91%无阻塞。该手术需要胸廓内动脉方面的技术技巧，但它有可能显著提高长期无事件生存率，并减少冠状动脉旁路移植术患者再次手术的需求。
