This video demonstrates the author’s technique for creating a Y-composite bilateral internal thoracic artery (BITA) conduit by performing an end-to-side anastomosis between the left and right internal thoracic arteries. The procedure is presented as a completely unedited operative recording played at twice the original speed, allowing visualization of every technical step without interruption. Particular emphasis is placed on the exact sequence of suture placement, which is the key determinant for achieving a widely patent and hemostatic anastomosis.
Operative Steps and Critical Details
The video illustrates preparation of the donor and recipient vessels, left internal thoracic artery (LITA) arteriotomy, and running sutures with 8-0 polypropylene. Critical technical details, including heel fixation, parachuting of the right internal thoracic artery (RITA), toe construction, deairing, and tension-free completion, are highlighted to minimize vessel-edge inversion, purse-stringing, and luminal compromise. The anastomosis is reproducible, typically requiring 10–20 minutes, and results in a flexible composite BITA conduit capable of reaching all coronary territories for complete arterial myocardial revascularization. This video is intended as a practical technical guide for surgeons performing multiarterial coronary bypass surgery.
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