ABSTRACT 45

Right mammary artery Stump to Coronary Artery Vein Grafts

LUDWIG C MÜLLER, REINHARD MITTERMAIR, JOHANNES BONATTI, MICHAEL RIEGER
Department of Cardiac Surgery, University Hospital of  Innsbruck, Austria

CABG in severe atherosclerosis of the ascending aorta requires a “no touch” technique to avoid cerebral embolism. OPCAB and use of IMA in situ grafts are recommended. For additional vein grafts alternative inflow vessels have to be used.

Due to various reasons we used the RIMA stump as inflow conduit.

Two patients with three vessel disease were treated. Epiaortic scan revealed protruding plaques in the aorta. CABG was performed off pump with a LIMA to LAD and RIMA free graft from the LIMA to the circumflex. An additional RCA vein graft was anastomosed end-to-end with the long RIMA stump.

Postoperative recovery was uneventful without signs of cerebral embolism or myocardial ischemia. Clinical investigation, Doppler scan and 3-dimensional reconstruction CT after 6 and 9 months showed well  perfused grafts and no recurrent angina.

Vein grafts from the RIMA stump to the RCA are a suitable solution for CABG in severe aortic sclerosis if a RIMA in situ graft would be to short. The RIMA in these cases is used as free Y-graft.