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Sequential coronary artery bypass grafting with both internal thoracic arteries on a beating heart

Authors: Zhelikhazheva M.V., Merzlyakov V.Yu., Baychurin R.K.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2018-12-2-183-190

For citation: Zhelikhazheva M.V., Merzlyakov V.Yu., Baychurin R.K. Sequential coronary artery bypass grafting with both internal thoracic arteries on a beating heart. Creative Cardiology. 2018; 12 (2): 183–90 (in Russ.). DOI: 10.24022/1997-3187-2018-12-2-183-190

Received / Accepted:  July 14, 2017 / August 11, 2017

Keywords: coronary artery bypass grafting sequential grafting bimammary coronary artery bypass grafting myocardial revascularization on a beating heart

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Abstract

Sequential bypass grafting is an effective method of myocardial revascularization in a number of situations where standard revascularization is not possible for a number of reasons (with atherosclerotically altered ascending aorta, hemodynamically significant lesions of the subclavian artery, deficiency of conduits, repeated operations of coronary artery bypass grafting, etc.). The subcutaneous vein is still widely used as an aortic/coronary artery shunt because of the ease of access, preparation and the possibility of use for multiple shunts. However, this type of shunt can develop intima hyperplasia and atherosclerotic lesions with an occlusion level of 10–15% in the first year after surgery. After 10 years, only 60% of venous shunts remain passable, of which only 50% have no signs of significant stenosis. There may also be complications in the lower limb where the fence occurred. The internal thoracic artery rarely develops atherosclerosis, and its diameter is usually comparable with the diameter of the coronary artery, which requires revascularization. In our case, the circumstances that led to the choice of the technique of sequential shunting were associated with a lack of conduits and the desire for more complete revascularization.

Acknowledgements. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.

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About Authors

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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