Extended Zone Right Internal Thoracic Artery Coronary Artery Bypass Grafting

We describe the extended zone right internal thoracic artery (RITA) technique, a simplified approach to create a composite graft. An in situ RITA is harvested midway down the sternum, preserving blood supply to the lower half of the right hemisternum. The extended zone RITA composite graft is then constructed with a surgical setup that provides a still field, which straightens the RITA under appropriate tension. A saphenous vein graft or radial artery is anastomosed in an end-to-side fashion approximately 1 inch proximal to the distal end of the RITA. The distal cul-de-sac is then obliterated with a suture ligature.