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Revista Brasileira de Cirurgia Cardiovascular
On-line version ISSN 1678-9741
GOMES, Walter J. et al. Off-pump grafting of the circumflex artery with pedicled retro-aortic right internal thoracic artery graft. Rev Bras Cir Cardiovasc [online]. 2005, vol.20, n.1, pp. 33-38. ISSN 1678-9741. http://dx.doi.org/10.1590/S0102-76382005000100009.
OBJECTIVE: Off-pump coronary artery bypass surgery (OPCAB) has been demonstrated to provide a reduction of cardiovascular events and mortality. Also, the bilateral use of the internal thoracic arteries (ITAs) can offer additional benefits, improving survival. We present the technique of OPCAB using both pedicled ATI grafts, with the right ITA (RITA) routed retro-aortic through the transverse sinus, to revascularize the branches of the circumflex artery (Cx). METHOD: Twenty-six patients, who underwent OPCAB with bilateral ATI grafts, were studied, where the left ATI (LITA) was used to revascularize the left anterior descending artery (LAD) and the pedicled RITA, routed through the transverse sinus and anastomosed to the branches of the Cx. Twenty-one patients were male and five female, the age ranging between 42 and 74 years. The morbidities observed in this cohort were previous myocardial infarction in 18 (69%) patients, diabetes mellitus in 10 (38%), renal failure in four (7.7%) and AIDS in one (3.8%) patient. RESULTS: No patient presented ECG changes or enzymatic increases in the postoperative period. The grafts per patient varied from two to four (average 3.0 grafts/patient). No cases of sternal infection or dehiscence were observed. One patient had a stroke on the 4º postoperative day and died. The postoperative hospital stay varied between 3 to 12 days (average 5.8±2.0 days). No late deaths or cardiovascular events were recorded. CONCLUSIONS: This technique makes off-pump grafting of the circumflex artery branches using the pedicled RITA possible and potentially enhances the benefits of coronary artery bypass surgery.
Keywords : Myocardial revascularization; Internal mammary-coronary artery anastomosis; Mammary arteries; Extracorporeal circulation.