Instructional Video
The "Y" Graft: How to do it
J. Ph. Etievent, MD, S. Chocron, MD, PhD, F. Clement,
MD
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video (2 1/2 minutes, best over network connection) |
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video segment |
The Principles
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| The use of the
pedicled right mammary artery is restricted
first of all because it is too short to reach
most of the marginal branches and secondly,
due to the need to use the end part of the
artery where the diameter is smaller and the
reactivity of the distal section is inversely
correlated to the diameter. Finally, crossing
the midline can complicate further surgery
if and when it necessary. For these reasons
our team has chosen to use the technique know
as the Y-graft. |
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Harvesting the Mammary Arteries |
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The left mammary
artery is harvested pedicled. The right mammary
artery is sectioned as a free graft, first
distally and then proximally. |
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The Technique |
| It is then positioned
so that the surgeon can prepare the proximal
end as needed. The left mammary artery is set
on a swab block. Its pleural fascia is opened
and an arteriotomy is performed. The heel of
the left mammary artery is grafted to the toe
of the right mammary artery by means of a running
suture using 8.0 polypropylene thread. |
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When the anastomosis
is completed the graft resembles a "Y". The
distal anastomosis are performed in the usual
fashion. As you can see, when completed the
right branch is sutured to the circumflex artery
and the left to the left anterior descending
artery. |
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Protecting With the Pleura |
| Next we divide
the mediastinal fat in front of the aortic
arch in order to provide a protective cushion
over the y-graft should a re-do operation be
necessary in the future. |
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Patency Rate |
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Results of this
procedure are shown in the coronary angiogram.
As we reported in 1994 a patency rate of 100%
was achieved in the left mammary artery. At
the time of the study the 73% patency rate
in the right mammary artery was the reflection
of the necessary learning curve. |
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