Technical aspects of double-skeletonized internal mammary artery grafting

Jacob Gurevitch, Amir Kramer, Chaim Locker, Itzhak Shapira, Yosef Paz, Menachem Matsa, Rephael Mohr*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background. Bilateral internal mammary artery (IMA) grafting is performed to provide complete arterial myocardial revascularization with the intention of decreasing postoperative return of angina and the need for reoperation. We present here technical views of double-skeletonized IMA grafting, and evaluate its clinical outcome. Methods. Skeletonized IMA is harvested gently with scissors and silver clips, without use of cauterization, and embedded in a small syringe filled with papaverine. Three strategies for arterial revascularization were employed in 762 consecutive patients: (1) the cross arrangement (242 patients, 32%), where the in situ right internal mammary artery (RIMA) is used for the left anterior descending artery (LAD), in situ left internal mammary artery (LIMA) to circumflex marginal branches and the gastroepiploic artery for the right coronary artery (RCA); (2) the composite arrangement (476 patients, 62%), where free IMA is attached end-to-side to the other in situ IMA; and (3) the natural arrangement (44 patients, 6%), where the in situ RIMA is connected to the RCA and in situ LIMA to LAD. Mean age was 66 years (range 30 to 92). Two hundred ninety-two patients (38%) were older than 70, and 229 (30%) were diabetic. Results. Operative mortality was 2.5% (n = 19). The mortality of urgent and elective cases was 1.2% (8 of 663), and that of emergency operation was 11% (11 of 99). There were 9 (1.2%) perioperative myocardial infarctions, and 10 patients (1.3%) sustained strokes. Sternal wound infection occurred in 14 (1.8%). Conclusions. The three strategies described here provide the surgeon with the versatility required for arterial revascularization with bilateral IMAs in most patients referred for coronary artery bypass grafting. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish
Pages (from-to)841-846
Number of pages6
JournalAnnals of Thoracic Surgery
Issue number3
StatePublished - Mar 2000
Externally publishedYes


Dive into the research topics of 'Technical aspects of double-skeletonized internal mammary artery grafting'. Together they form a unique fingerprint.

Cite this