[The complex grafting of the internal thoracic artery to the coronary arteries]

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Vascular Grafting

Context:

• Complex coronary artery bypass grafting (CABG) procedures present significant surgical challenges.
• The internal thoracic artery (ITA) is a preferred conduit for coronary revascularization due to its long-term patency.
• Advanced surgical techniques are crucial for managing complex graft configurations and ensuring optimal patient outcomes.

Purpose:

• To describe the surgical techniques and outcomes of complex internal thoracic artery (ITA) to coronary artery bypass grafts.
• To evaluate the feasibility and safety of performing these intricate anastomoses on a beating heart using specific anesthetic protocols.
• To report on the types of ITA grafts utilized, including bilateral, bifurcated, sequential, and combined arterial grafts.

Summary:

• A total of 34 complex ITA to coronary artery grafts were performed, employing various configurations such as bilateral (20), bifurcated (8), sequential (4), "free" (1), and combined left ITA/right radial artery (1).
• The "no-touch" technique was applied to the aorta, with cardiopulmonary bypass initiated via left common femoral artery cannulation.
• The surgery was conducted on a beating, warm, and vented heart with induced severe bradycardia using a short-acting beta-1 blocker to minimize myocardial oxygen demand and facilitate anastomosis construction.

Impact:

• The study demonstrates the successful application of advanced surgical techniques for complex arterial grafting in coronary artery bypass surgery.
• The described method, including "no-touch" aorta and beating-heart approach with bradycardia, achieved zero operative mortality in this cohort.
• This approach offers a potentially safer and effective strategy for complex coronary revascularization, contributing to the field of cardiovascular surgery.