Thoralf M. Sundt, Hendrick B. Barner, Cynthia J. Camillo, William A.. Gay

Washington University School of Medicine

St. Louis, Mo.

Proximal anastomosis of the radial artery (RA) to the side of the internal thoracic artery (ITA) permits complete arterial revascularization with two conduits in most patients. Our 4 ½ years, 564 patients aged 40 to 81 (mean 61.4± 8.7) years had primary coronary bypass with this technique. Demographics were; male sex 413 (73 percent), hypertension 272 (3 percent), prior cerebrovascular disease 42 (8 percent) and peripheral vascular disease 52 (9 percent). Triple vessel disease was present in 440 (78 percent), and 427 (77 percent) experience Class III or IV angina. Left ventricular function was severely depressed (ejection fraction ±W<35 percent) in 61 (11 percent). The mean number of distal anastomose was 3.6 (range two to seven). Supplemental conduits were used in 44 patients (8 percent). There was one (30 day) death (0.2 percent). The incidence of Q wave MI was 6 percent (32 patients) and low output syndrome 2 percent (14 patients). There were no episodes of hypoperfusion. Complications included: reoperation for bleeding in 19 (3 percent), stroke in nine (3 percent), and mediastinal infection in four (7 percent). Angiography for clinical indications in 27 patients at four days to 40 months postoperatively (mean 12.4± 10.8 months) demonstrated three RA grafts to be occluded proximally, one of which was patent between distal anastomoses. Distal anastomotic patency was 42 of 48 (88 percent) RA and 40 to 40 ITA. The RA in a "T Graft" configuration will achieve full arterial revascularization with low operative risk and acceptable patency at one year.