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

Tuesday, December 19, 2023

Enginoev S, Ziankou A, Ekimov S, et al. No-Touch Aorta Off-Pump Coronary Artery Bypass Using Bilateral Internal Mammary Arteries. December 2023. doi:10.25373/ctsnet.24867201

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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Congratulations on the fantastic technique. It would be of interest though to know the degree stenosis particularly of the RPD and if use of Radial instead of SVG was considered in this relatively young patient . Otherwise the "Ι" graft is quite ingenious. Regards
Dear ,Constantine Thank you very much for your inquiry and interest in the video. However, I would like to clarify a few points: To date, the 'No touch vein' technique demonstrates excellent results, comparable to those of the right internal mammary artery and the radial artery. Currently, there is no evident advantage of the radial artery over the 'No touch vein' method. The 'No touch vein' is less prone to spasms, easier to harvest, and associated with fewer local complications. Regarding the degree of stenosis of the Coronary Artery in this case, it is indeed more than 90%. Thank you again for your interest and inquiry. Please feel free to reach out if you have any more questions or require further information. Sincerely, SOSLAN

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