Deep Dive Into Total Arterial Anaortic Off-Pump Coronary Artery Bypass Grafting: LIMA to LAD Anastomosis

In our previous video, a radial artery to LIMA ‘T’ graft was performed without manipulating the ascending aorta. In this video, Professor Tristan Yan performs a side-to-side LIMA to LAD anastomosis as part of the no-touch anaortic off-pump surgery. This technique was first pioneered by Dr. Don Ross and Dr. John Bereton at the Royal North Shore Hospital, and has subsequently been popularized by several OPCAB surgeons in Sydney, Australia.

The advantage of using a side-to-side anastomosis is that the operator can pick up and maneuver the distal portion of the LIMA during grafting without damaging the vessel. In addition, at the end of the anastomosis, we can test the patency of the graft by a two-step process: 1) releasing the proximal LAD silastic sling, while the bulldog is still on the LIMA to confirm the patency of the anastomosis from the native LAD; and 2) tightening the proximal LAD silastic sling and releasing the bulldog on the LIMA graft to check the blood flow from the LIMA graft. Finally, the distal end of the LIMA is then simply closed with clips and secured on the epicardium. 

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