Off-Pump Coronary Artery Bypass With Bilateral Internal Thoracic Arteries in Left Main Disease

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.

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