Left Internal Mammary Artery, Radial Artery, Y Graft Operation and Survival Curves
(Upper panel) Left internal mammary artery, radial artery, Y-graft (LIMA-RA-Y) operation. The LIMA is used to revascularize the left anterior descending territory, and the composite radial artery (RA) graft is used to revascularize the circumflex and right coronary territories. Both LIMA and the left RA can be harvested simultaneously; avoidance of a second internal mammary artery may result in lower risk of mediastinitis than both internal mammary arteries being harvested. (Lower panel) Survival LIMA-RA-Y versus left internal mammary artery and supplementary saphenous vein graft (LIMA + SVG) (matched n = 464). Propensity score–matched survival up to 21 years after surgery shows significantly lower survival for the LIMA + SVG operation, with the hazard ratio (HR) for mortality 26% higher. The interpretation is that progressive failure of SVG leads to adverse cardiac events, which lead to an excess of death in this arm. Cox = Cox proportional hazards; KM = Kaplan-Meier.