A technique to protect the left internal thoracic artery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Procedures

Background:

• The left internal thoracic artery (LITA) naturally shifts medially after harvest.
• This medial shift poses significant risks during sternal reentry for repeat cardiac surgery.
• Existing methods may not adequately address LITA repositioning challenges.

Purpose of the Study:

• To present a novel technique for posterior and lateral repositioning of the harvested in-situ LITA.
• To enhance safety during sternal reentry for redo myocardial revascularization and other cardiac procedures.
• To mitigate the risks associated with the medial displacement of the LITA.

Main Methods:

• Mobilization of the in-situ left internal thoracic artery.
• Creation of a thymic flap for tissue coverage and support.
• Development of a pleuromediastinal groove to guide and secure the LITA's position.
• Surgical technique focused on posterior and lateral displacement of the LITA.

Main Results:

• The described technique facilitates safe posterior and lateral repositioning of the LITA.
• This method aims to reduce the hazard of sternal reentry in redo cardiac operations.
• Successful implementation of the thymic flap and groove technique is demonstrated.

Conclusions:

• The presented technique offers a viable solution for managing the harvested LITA's position.
• This approach can improve safety outcomes for patients requiring repeat sternotomy.
• Further studies may validate the long-term efficacy and safety of this repositioning strategy.