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Off-Pump Coronary Artery Bypass With Bilateral Internal Mammary Arteries

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Version 2 2019-08-06, 17:17
Version 1 2019-07-10, 16:02
posted on 2019-08-06, 17:17 authored by Fernando Barbosa

Editorial note: The video in version 1 of this article is of disputed ownership. Version 2 or later should be referenced.

The bilateral internal mammary arteries technique for off-pump coronary artery bypass is a safe technique with long-term patency and low morbidity and mortality. The author usually uses total arterial myocardial revascularization using bilateral internal mammary arteries for patients younger than 75 years old. The left and right mammary arteries have the longest patency described of any type of graft that can be use in cardiac surgery.

Left and right mammary artery composite Y-grafts were constructed using 8-0 Prolene® sutures. The author uses 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.

Additional Resources

  1. Rieß FC, Behrendt CA, Amin W, 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? Eur J Cardiothorac Surg. 2017;52(5):917-923.
  2. Navia DO, Vrancic M, Piccinini F, et al. Myocardial revascularization exclusively with bilateral internal thoracic arteries in T-graft configuration: effects on late survival. Ann Thorac Surg. 2016;101(5):1775-1781.
  3. Buttar SN, Yan TD, Taggart DP, Tian DH. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis. Heart. 2017;103(18):1419-1426.
  4. Pasrija C, Ghoreishi M, Shah A, et al. Bilateral internal mammary artery use can be safely taught without increasing morbidity or mortality. Ann Thorac Surg. 2018;105(1):76-82.
  5. Iribarne A, Schmoker JD, Malenka DJ, et al; Northern New England Cardiovascular Disease Study Group. Does use of bilateral internal mammary artery grafting reduce long-term risk of repeat coronary revascularization? A multicenter analysis. Circulation. 2017;136(18):1676-1685.
  6. Kajimoto K, Yamamoto T, Amano A. Coronary artery bypass revascularization using bilateral internal thoracic arteries in diabetic patients: a systematic review and meta-analysis. Ann Thorac Surg. 2015;99(3):1097-1104.


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