RIMA Inflow for Venous Sequential Graft in a Hostile Aorta

Finding a heavily calcified and/or atheromatous aorta after sternotomy in a coronary bypass grafting (CABG) operation can be extremely unpleasant. The ideal treatment is a multiarterial off-pump surgery that avoids any aortic manipulation; however, this can be technically challenging for surgeons with limited exposure to the use of sequential arterial grafts. During the last 20 years, the authors have utilized the alternative option presented in this video.  

The inferior and lateral vessels were grafted with a sequential saphenous vein graft. The inflow was then provided by the proximal right internal mammary artery (RIMA), which was anastomosed in an end-to-end fashion. The authors believe that young surgeons should keep this in mind to offer a complete revascularization without embarking on a procedure that could be very difficult. 

References

1. G. Rescigno et al. Porcelain Aorta in Coronary Artery Bypass Graft Operations: an Alternative Approach Heart Surg Forum 2003; 6: E48-9

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