All internal thoracic artery composite graft revascularization.

The aim of this study was to determine the most efficient design of composite grafts and clarify the technical feasibility rate of composite grafting using internal thoracic artery exclusively in patients undergoing triple-vessel revascularization. Retrospective analysis of 104 consecutive patients was carried out. An in situ left internal thoracic artery graft for the left anterior descending artery area, with attachment of the right internal thoracic artery to the side of the left internal thoracic artery to revascularize the circumflex and right coronary vessels, was the most efficient graft design. The technical feasibility rate was 80% (83/104 patients). The mean number of distal anastomoses for the entire group was 3.8+/-0.8 per patient. Intraoperative left internal thoracic artery flow rate was 91.6+/-37.8 mL.min-1. With more experience, it is thought that the technical feasibility rate could be increased.