Total Arterial Complete Revascularization Using Bilateral IMA with Mitral Valve Replacement

A 62-year-old male was admitted in cardiogenic shock. He had previously received a dual chamber pacemaker for complete heart block. A coronary angiogram revealed triple vessel disease. A transthoracic echo showed that the patient had severe ischemic mitral regurgitation (coaptation depth of more than 10 mm), and severe left ventricle dysfunction (EF 25%). He was stabilized on IABP and was taken into surgery. He had varicose veins on both legs. He underwent total arterial complete revascularization with bilateral internal mammary artery and mitral valve replacement using a 27 mm mosaic valve. Both internal mammary arteries were dissected, and LIMA RIMA Y was made using 8-0 prolene sutures. A pump-assisted CABG was performed with LIMA to D1, LAD, and RIMA to OM1 and RCA.

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