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Heart, Lung and Circulation

RARAY Operation: Operative Description and Early Results for Achieving Total Arterial Coronary Revascularisation

      Background

      Total arterial revascularisation may prolong postoperative survival following coronary surgery due to avoidance of late saphenous vein graft (SVG) failure leading to ischaemic cardiac events. The left internal mammary artery (LIMA) is routinely used for CABG but harvest may adversely affect lung function and reduce sternal vascular supply. Early experience of a novel reconstruction with exclusive reliance on two radial arteries (RA) joined as a Y graft (RARAY) is presented.

      Methods

      One RA is anastomosed to the ascending aorta and used to revascularise the left anterior descending artery coronary territory; and a second RA is joined to the first 4–6 cm from the origin, approximating the lateral border of the pulmonary artery and used to revascularise the circumflex and right coronary territories. No LIMA is used. The radial artery was harvested open with diathermy and metal clips and since 2008, all patients received intravenous vasoconstrictors from the commencement of the anaesthetic.

      Results

      From 2002 to 2019, 28 patients underwent RARAY for specific indications of prior use or reasons to avoid LIMA harvest, preservation of lung function, minimisation of bleeding risk from antiplatelet agents and extra length of RA to graft distal coronary targets beyond usual reach for LIMA. There was no RA spasm, no in-hospital death and no patient returned with symptoms of angina.

      Conclusions

      The early experience of the RARAY operation for three coronary territory revascularisations are satisfactory.

      Keywords

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