“Pouch Technique” Makes Proximal Anastomosis of Free Internal Thoracic Artery Graft to Ascending Aorta Easy and Safe in Coronary Artery Bypass Surgery

Abstract

Purpose: The proximal anastomosis of free right internal thoracic artery to ascending aorta is technically difficult when the caliber is not enough.Methods: We incise the proximal stump of the graft longitudinally for 10 mm. One side of start point of longitudinal incision is sewn to the end point of incision by 7-0 polypropylene. The folded sideline (5 mm length) is then closed with a running suture, then formation of pouch like anastomotic end is accomplished.Results: We used this technique in consecutive 34 patients who underwent coronary artery bypass surgery including revascularization to circumflex arteries. Postoperative angiography revealed 97% patency. It does not need another graft material like saphenous vein or radial artery, and possible not only in on pump surgery but also in off pump.Conclusion: This new “Pouch technique” will make it easy to use right internal thoracic artery as a free graft in coronary artery bypass surgery.