Full-length median sternotomy was used to perform the surgical procedure. The LIMA graft was accurately skeletonized at full length. Afterwards, in order to prove the feasibility of a double revascularization with LIMA and a T-graft, the LIMA was measured with a cord divided into two parts after the LIMA-LIMA T-graft was found to be feasible intraoperatively if the angle between the target vessels was significantly < 60° and the distance < 6 cm [9 (
link)]. The objective and top priority of surgery was to achieve complete revascularization. Anastomoses were performed with 8-0 sutures (PROLENE
® Polypropylene Suture, Ethicon US, LLC. 2020. 085133-171129). In certain procedures, the anastomoses (e.g., LIMA on a diagonal branch, and, further, on a LAD or intermediate branch, and, further, on a marginal branch) were performed sequentially. Transit time flowmetry to assess bypass flow was routinely achieved by using a duplex ultrasonic probe (Medistim, Oslo, Norway).
Rustenbach C.J., Djordjevic I., Eghbalzadeh K., Baumbach H., Wendt S., Radwan M., Marinos S.L., Mustafi M., Lescan M., Berger R., Salewski C., Sandoval Boburg R., Steger V., Nemeth A., Reichert S., Wahlers T, & Schlensak C. (2022). Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes. Medicina, 58(10), 1415.