Deep Dive Into Total Arterial Anaortic Off-Pump Coronary Artery Bypass Grafting: Dual Inflow BIMA In Situ to LAD and RCA

In this deep dive series of videos produced by Professor Tristan Yan from the Royal Prince Alfred Hospital in Sydney, Australia, he demonstrates a technique of total arterial off-pump coronary artery bypass grafting without touching the ascending aorta to reduce stroke risk. 



This video demonstrates another grafting configuration that achieves complete revascularization without manipulating the ascending aorta (anaortic and off-pump) and utilizing total arterial grafts. The bilateral internal mammary arteries are harvested in a fully skeletonized fashion. The left internal mammary artery (LIMA) in situ graft is used to supply the anterior wall. The right internal mammary artery (RIMA) in situ graft is used to revascularize the right coronary artery (RCA) territory. 

Professor Yan places an octopus evolution tissue stabilizer to expose the LAD, and then places a silastic sling around it proximally. The LAD is opened, and a soft shunt is placed into the lumen. A side-to-side anastomosis of the LIMA to the LAD is performed. This is done so that the patency of the anastomosis can be tested twice by checking the flow from the native LAD and that of the proximal LIMA respectively, across the anastomosis and out of the LIMA distally. Similarly, the RIMA to RCA anastomosis is demonstrated using the side-to-side grafting technique. 

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