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Technique for Reoperative Median Sternotomy in the Presence of a Patent Left Internal Mammary Artery Graft
Author(s) -
Elami Amir,
Laks Hillel,
Merin Gideon
Publication year - 1994
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1994.tb00837.x
Subject(s) - medicine , sternum , median sternotomy , retractor , dissection (medical) , anastomosis , mammary artery , anatomy , surgery , great vessels , aorta , artery
A bstract Damage to a patent left internal mammary artery (MA) graft during reoperation can be catastrophic. An organized approach to reenter the mediastinum in the presence of a functioning left IMA graft is described. The sternum is opened using an oscillating saw to carefully divide the anterior and posterior tables. The right side is then dissected out first, exposing the aorta and right atrium. After placing pursestring sutures for cannulation, attention is turned to the left side. An IMA retractor is used to elevate the left edge of the sternum in incremental stages. The dissection is begun at the inferior end of the sternum, exposing the distal anastomosis first and then dissecting superiorly anterior to the IMA. A Doppler flow detector probe is used to assist in locating the artery in the adhesions. ( J Card Surg 1994;9:123–127 )