The left internal thoracic artery and radial artery composite graft in off-pump coronary artery bypass grafting.

Arterial multivessel bypass grafting without extra corporeal circulation and manipulation of the ascending aorta should be a good surgical option for the treatment of coronary artery disease. An internal thoracic artery (ITA)-radial artery (RA) composite graft was used for this purpose. Between July 2000 and October 2001, we employed the LITA-RA composite graft for off-pump coronary artery bypass in 15 cases. Mean patient age was 71.3 +/- 5.8 years old. Left main trunk disease was present in six patients and triple-vessel disease in four patients. Preoperative concomitant disease was renal dysfunction in three cases, cerebrovascular disease in four and diabetes mellitus in five cases. Two patients had a so-called bad aorta. Twelve elective operations and three urgent operations were carried out for unstable angina. Two to four (mean 2.6 +/- 0.7) anastomoses were performed per patient. Complete revascularization was achieved in 12 out of 15 patients. Mean operating time was 335 +/- 53 min. Mean intraoperative blood loss was 595 +/- 375 ml and nine patients underwent the operation without blood transfusion. There was no PMI, no brain disorder, and no death. Postoperative coronary angiography in all patients documented a good patency rate (LITA 15/15, RA 21/21, right gastroepiploic artery (RGEA) 2/2, and saphenous vein graft (SVG) 0/2). LITA-RA composite grafting in off-pump coronary artery bypass enables arterial multivessel revascularization using an aortic no touch technique. This can be done with minimum postoperative complications and without risk of cerebral infarction even in patients at high risk for extracorporeal circulation (ECC).