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OBJECTIVE: T-graft technique is often used to achieve a complete arterial revascularization with two arterial conduits. Avoidance of aortic trauma is also cited as an advantage. There are works in the literature that show a normal coronary flow reserve of the single influx via an internal mammary artery, but there is increasing evidence that a complete flow reserve cannot be achieved. The aim of the present study poses is whether the T-graft bypass technique can achieve a myocardial flow reserve analogous to that achieved after conventional supply employing individual grafts.
METHODS: From 3/2011 through 7/2013, a total of 24 patients (96 % male, aged 65±9 years), were included in the prospective, randomized study (NCT01170988). Inclusion criteria were: three-vessel coronary disease (degree of stenosis at least 70 %), good LV function, IMA bypass capability, and willingness to undergo an MRT follow-up study 6-12 weeks after surgery. The MRT myocardial perfusion analysis was initially performed visually, at rest, under adenosine. In the semi-quantitative analysis of the 16 sectors that followed, a perfusion reserve below 1.5 was assessed positively. Tissue differentiation occurred by means of contrast imaging (Late Enhancement).
RESULTS: 5 patients could not be considered for the evaluation (Lost to follow up, MRT contraindication). Contrary to the randomization, one patient was treated with a conventional bypass technique (n=8 conventional technique/ n=11 T-graft technique). The magnetic resonance imaging study revealed normal ventricular function for both arms of the study (Table 1). Non-transmural posterior wall scarring was demonstrated among 50 % of the patients in each case. Among n=4/8 (50 %) of the patients in the T-graft group and n=6/11 (54 %) of the conventional bypass group, the perfusion measurement, which was supported by adenosine, exhibited a diminished perfusion reserve.
CONCLUSIONS: Given the small number of cases, no distinction could be drawn between the two groups. In each case, the high proportion of patients with perfusion deficits and non-transmural posterior wall scars with clinically unremarkable post-operative courses is striking.

	single bypass	t-graft bypass
LVEDVI	76±13	69±9
LVESVI	30±10	27±8
LVSVI	46±10	41±9
LVEF%	60±9	61±10