Off-Pump Coronary Artery Bypass With Bilateral Internal Thoracic Arteries in Left Main Disease Fernando Barbosa Claudio Moyano Andres Otero Ana Duret Leandro Goldstraj Damian Morelli Nicolas Jaralampio Granillo Matias 10.25373/ctsnet.10029491.v1 https://ctsnet.figshare.com/articles/media/Off-Pump_Coronary_Artery_Bypass_With_Bilateral_Internal_Thoracic_Arteries_in_Left_Main_Disease/10029491 <p>Left main disease is a challenge for any cardiac surgeon. There are current discussions about the best technique and the best grafts for this problem. The bilateral internal thoracic arteries technique for off-pump coronary artery bypass is a safe technique with long-term patency, low morbidity, and low mortality. Very frequently, the patients that have left main disease have a left ventricular function decrease, and those patients have the best chance with this off-pump technique. In these cases, the use of the bilateral internal thoracic artery is a safe and long-term solution. The authors usually use total arterial myocardial revascularization using the bilateral internal mammary for patients youngers than 75 years old. The left and right mammary arteries have the longest patency described than any other type of graft that can be used in cardiac surgery. Left and right thoracic arteries composite “Y” grafts were constructed using 8-0 Prolene® sutures. The authors used the same suture line in each anastomosis. The use of bilateral internal mammary arteries for myocardial revascularization has become the standard technique according to recent guidelines.<br></p><p><strong>References</strong></p><ol><li>Fukui T, Tabata M, Manabe S, Shimokawa T, Shimizu J, Morita S, et al.Off-pump bilateral internal thoracic artery grafting in patients with left main disease. <a href="https://doi.org/10.1016/j.jtcvs.2009.11.069"><em>J Thorac Cardiovasc Surg</em>. 2010 Nov;140(5):1040-1045.</a></li><li>Rieß FC, Behrendt CA, Amin W, Heller S, Hansen L, Winkel S, et al. Complete arterial revascularization using bilateral internal mammary artery in T-graft technique for multivessel coronary artery disease in on- or off-pump approach: does gender lose its historical impact on clinical outcome? <a href="https://doi.org/10.1093/ejcts/ezx287"><em>Eur J Cardiothorac Surg</em>. 2017 Nov 1;52(5):917-923.</a></li><li>Otaki M, Lust RM, Sun YS, Norton TO, Spence PA, Zeri RS, et al. Bilateral vs single internal thoracic artery grafting for left main coronary artery occlusion. <a href="https://doi.org/10.1378/chest.106.4.1260"><em>Chest</em>. 1994 Oct;106(4):1260-1263.</a></li><li>Navia DO, Vrancic M, Piccinini F, Camporrotondo M, Dorsa A, Espinoza J, et al. Myocardial revascularization exclusively with bilateral internal thoracic arteries in T-graft configuration: effects on late survival. <a href="https://doi.org/10.1016/j.athoracsur.2015.10.074"><em>Ann Thorac Surg</em>. 2016;101(5):1775-1781.</a></li><li>Barner HB, Naunheim KS, Willman VL, Fiore AC. Revascularization with bilateral internal thoracic artery grafts in patients with left main coronary stenosis. <a href="https://doi.org/10.1016/1010-7940(92)90077-b"><em>Eur J Cardiothorac Surg</em>. 1992;6(2):66-69;discussion 70-1.</a></li><li>Kajimoto K, Yamamoto T, Amano A. Coronary artery bypass revascularization using bilateral internal thoracic arteries in diabetic patients: a systematic review and meta-analysis. <a href="https://doi.org/10.1016/j.athoracsur.2014.09.045"><em>Ann Thorac Surg</em>. 2015;99(3):1097-1104.</a></li><li>Iribarne A, Schmoker JD. Does use of bilateral internal mammary artery grafting reduce long-term risk of repeat coronary revascularization? A multicenter analysis. <a href="https://doi.org/10.1161/CIRCULATIONAHA.117.027405"><em>Circulation</em>. 2017;31;136(18):1676-1685.</a></li><li>Pasrija C, Ghoreishi M, Shah A, Rouse M, Gammie JS, Kon ZN, et al. Bilateral internal mammary artery use can be safely taught without increasing morbidity or mortality. <a href="https://doi.org/10.1016/j.athoracsur.2017.05.075"><em>Ann Thorac Surg</em>. 2018;105(1):76-82.</a></li></ol> 2019-10-29 21:40:00 Cardiac Coronary Disease Coronaries Myocardial Infarction Surgery