Circumflex coronary artery bypass grafting via transverse sinus

Grafting the circumflex coronary artery has been more difficult technically than the right or anterior descending because of its posterior location and the angles of its marginal branches. However, grafting this artery has been substantially simplified by a method wherein the graft is passed directly through the transverse sinus and anastomosed to the back of the ascending aorta. This follows the most direct course to the ascending aorta and the graft is much shorter than one brought anterior to the heart. There is little chance of kinking the graft, since its angle of attachment is ideal, and due to the anatomical configuration of the transverse sinus, there is more room for the graft and compression is unlikely. This allows more room on the anterior surface of the aorta for grafts to other coronary arteries. This method has been used in 50 cases and blood flows have been excellent. Twelve of these cases have been restudied postoperatively and the grafts are patent.