No-Touch Aorta Off-Pump Coronary Artery Bypass Using Bilateral Internal Mammary Arteries

In a number of patients with ischemic heart disease, coronary artery bypass grafting (CABG) is the method of choice. Some studies and meta-analyses have shown benefits of bimammary coronary artery bypass grafting (BIMA), including better long-term survival, lower hospital mortality, cerebrovascular accidents, and need for revascularization. When both ITAs are used, the skeletonized technique appears to reduce the incidence of sternal wound infection after CABG in comparison to the pedicled technique. There is no difference between the use of BIMA in situ or a composite graft, both in the early and in the long-term period. 

The no-touch saphenous vein graft (SVG) for CABG maintains a patency and, after 16 years, is comparable to the left internal thoracic artery, according to a randomized trial. When anastomosing the SVG with IMA, it is positive and the patency is expected. The benefits of the no-touch technique, including reducing hospital mortality, MACCE, and stroke have been proven in many studies and meta-analyses. The use of epiaortic scanning, intraoperative transit-time flow measurement, and high frequency ultrasound assessment should be routine in coronary surgery. Some authors in different years have proposed methods for using single-graft SVG and BIMA off pump, including the no-touch vein method. 

The authors of this video combined recent positive trends in coronary artery bypass grafting, including the use of skeletonized BIMA, no-touch saphenous vein, epiaortic scanning, intraoperative transit time flow measurement, and high-frequency ultrasound assessment to demonstrate their technique.

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