The use of composite coronary artery bypass grafts from the left internal mammary
artery (LIMA) has increased over the last 20 years. Total arterial revascularisation
can be achieved with two arterial conduits and is associated with a reduced risk of
stroke. However, the traditional coronary bypass graft configurations of the in situ
LIMA and aorto-coronary saphenous vein grafts remain as the mainstay of coronary bypass
surgery in most centres. Concerns regarding composite Y grafts relate to (1) the adequacy
of a single inflow for all coronary bypass grafts; (2) the risk of compromising the
LIMA flow to the left anterior descending coronary artery; (3) the effects of competitive
flow on graft patency; and (4) the use of sequential coronary anastomoses. The evidence
upon which these concerns are based will be discussed along with the evidence relating
to the use of the various second conduit options.
Keywords
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Article info
Publication history
Published online: October 28, 2017
Accepted:
October 16,
2017
Received:
June 27,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
