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Updated: May 8, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Off-pump coronary artery bypass grafting using skeletonized in situ arterial grafts
Tohru Asai1, Tomoaki Suzuki, Hiromitsu Nota
1Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Shiga, Japan.
Insights
Skeletonization of arterial grafts, including the internal thoracic artery (ITA) and right gastroepiploic artery (GEA), offers advantages for coronary artery bypass grafting (CABG). This technique enhances graft quality and simplifies off-pump coronary artery bypass (OPCAB) procedures.
Area of Science:
- Cardiovascular Surgery
- Surgical Techniques
- Graft Harvesting
Background:
- Skeletonization is an advanced graft harvesting technique for coronary artery bypass grafting (CABG).
- Skeletonization of the internal thoracic artery (ITA) offers benefits like reduced sternal ischemia and mediastinitis risk.
- Harvested ITA via skeletonization is longer and larger than pedicled ITA.
Purpose of the Study:
- To describe surgical techniques for skeletonization of arterial grafts.
- To detail off-pump coronary artery bypass (OPCAB) using exclusively in situ skeletonized grafts.
- To present a simplified and secure method for technically demanding CABG operations.
Main Methods:
- Describes skeletonization of the right gastroepiploic artery (GEA) in three steps: passing vessel loops, unroofing surrounding tissue, and sealing/severing branches.
- Details the use of skeletonized bilateral ITA and GEA for coronary artery revascularization.
- Employs off-pump coronary artery bypass (OPCAB) exclusively with these in situ grafts.
Main Results:
- Skeletonization of GEA prevents vasospasm, promotes dilatation, and facilitates anastomosis.
- Skeletonized ITA and GEA can address most coronary targets without ascending aorta manipulation.
- In a series of over 1,000 patients, the stroke rate was 0.5%.
Conclusions:
- Skeletonization of arterial grafts (ITA and GEA) provides a simple and secure method for OPCAB.
- This technique offers advantages in graft quality and surgical efficiency.
- OPCAB using skeletonized in situ grafts provides optimal coronary revascularization.
Abstract:
Skeletonization is an advanced technique of graft harvesting for coronary artery bypass grafting (CABG), and while it requires meticulous attention, it has many advantages. For example, skeletonization of internal thoracic artery (ITA) can minimize sternal ischemia and lower the risk of mediastinitis, and is longer and larger than pedicled ITA. In this article we describe the surgical techniques demonstrated in our video, which details our techniques of skeletonization of arterial grafts and off-pump coronary artery bypass (OPCAB) exclusively using these in situ grafts. Our method of right gastroepiploic artery (GEA) skeletonization has only three technical steps. The first step is to pass thin vessel loops under the GEA. The second step is to unroof the tissue surrounding the GEA. The last step is to seal and sever all the branches. Skeletonization of the GEA not only prevents vasospasm but also leads to GEA dilatation, and facilitates inspection and makes sequential anastomosis easier. Bilateral use of the skeletonized ITA and use of the skeletonized GEA can cover most coronary artery target sites without any manipulation of the ascending aorta. In our consecutive series of over 1,000 patients, the stroke rate was 0.5%. Our method helps to make the technique simple and secure in this technically demanding operation, and we believe that OPCAB with these grafts provides the best possible coronary revascularization.
