Original ArticlesTechnical aspects of double-skeletonized internal mammary artery grafting
Section snippets
Harvesting and preparing the skeletonized IMA
In our harvesting technique, we basically follow instructions and recommendations given before by Cunningham and associates [5], and add our experience. A standard median sternotomy incision is used with only rare application of bone wax. Later dissection of the IMA is easier if meticulous hemostasis is obtained on the sternal edges to avoid accumulation of blood in the field. The IMAs are dissected as skeletonized arteries [3], before heparin administration, to decrease the risk of damage and
Results
We prospectively evaluated the use of double-skeletonized IMA in 762 patients between April 1996 and April 1998. Mean age was 66 years, range 30 to 92 years, 595 (78%) were men, and 167 (22%) women. Two hundred ninety-two (38%) were older than 70, 229 (30%) were diabetic, and 141 (18%) had left ventricular dysfunction. Myocardial preservation technique was intermittent anterograde warm blood cardioplegia. Mean bypass time was 102 minutes, and cross-clamp time was 85 minutes. Average number of
Comment
This report focuses on technical aspects of bilateral skeletonized IMA grafting. The technical experience we gathered with the first 762 patients operated upon is detailed above. The patients here are typical for an urban population (relatively old), and this technique was used in 71% of the patients who underwent CABG in our institution, including those older than 70 years of age and diabetic patients, over a relatively short period of time (3 years). The only important contraindication for
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