Side-to-side Anastomosis Technique using Four Interrupted Sutures for Sequential Grafting with an Arterial Graft

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Objective: Sequential grafting using an arterial graft is essential for achieving complete revascularization and long-term patency with complex multivessel diseases; however, technical difficulties still exist. Side-to-side anastomosis using 4 interrupted sutures for sequential grafting is effective for implementing complete revascularization for such complex coronary lesions. In this study, we evaluated the effectiveness of this technique for small coronary arteries using arterial grafts. Materials and methods: Between March 2010 and March 2017, the side-to-side technique with 4 interrupted sutures and arterial grafts for targeting small coronary arteries, smaller than 1.0 mm in diameter, was performed for 72 sequential anastomoses (69 for proximal touchdown site of sequential graft and 3 for distal) in 68 patients (57 men and 11 women; mean age, 64.4 ± 9.0 years). Results: This technique was frequently used for the proximal portion of the left internal thoracic artery (LITA)-diagonal branch(D)-left anterior descending coronary artery (35 anastomoses; 49%), LITA-D/circumflex coronary artery (Cx)-Cx (19 anastomoses; 26%) sequential grafting. Postoperative coronary angiography was performed for 65 of 72 anastomoses (90%). Fitz-Gibbon grade A was found for 64 of 65 (98%), grade B was found for 1 of 65 (2%), and grade O was not observed. Conclusion: The side-to-side anastomosis technique with 4 interrupted sutures and arterial grafts for small coronary arteries is versatile, safe, and associated with excellent short-term outcomes.