Early and Late Results of LAD Territory Revascularization with Right Internal Mammary T-graft The `Reverse-Composite` Configuration

Background: The use of bilateral internal mammary arteries (BIMA) for myocardial revascularization was shown to improve long-term survival and decrease the rate of repeat interventions. A key technical factor for complete arterial revascularization is a sufficient length of the mammary graft. Apart of Skeletonization of both internal mammary arteries optimizing graft length another strategy is the use of the right internal mammary as a `Composite` free graft arising from the left internal mammary `Reverse-Composite’ is another technique in which the RIMA is arising as a free graft from the LIMA and used for LAD territory revascularization while the LIMA is used for LCX revascularization.

Objectives: The purpose of this study is to compare the early and long term outcome of the classical `Composite`, where the LIMA is anastomosed to the LAD, with the `Reverse-Composite` configuration.

Methods: We report the outcome of 1,334 patients who underwent CABG in Tel-Aviv Sourasky Medical Center, using bilateral internal mammary in `Composite` versus "Reverse-Composite" configuration, between January 1996 to august 2011.

Results: Twelve hundreds and sixteen patients underwent classical `Composite` configuration while 118 patients underwent `Reverse-Composite` revascularization. There was no difference between the groups in 30 days mortality, CVA or sternal wound infections. Furthermore, the difference in the late mortality (follow up of 17.5 years) between the groups did not reach statistical significance.

Conclusion: This study suggests that revascularization of the LAD-territory with a classical `Composite` manner as good as `Reverse-Composite` configuration using the RIMA for LAD territory revascularization.