THE FULLY NO-TOUCH TECHNIQUE FOR THE INTERNAL THORACIC CORONARY-ARTERY ANASTOMOSIS

Extreme technical accuracy is crucial in coronary artery surgery Altho ugh late graft patency depends mostly upon the patient's own biochemic al status in chronic ischemic patients who have undergone elective sur gery, graft disease is certainly promoted by an inaccurate technique o r by careless arterial harvesting, which may cause both intimal lesion s and anastomotic strictures. We describe a technique of internal thor acic-coronary artery anastomosis that fully prevents contact between v essels and surgical instruments. In order to enable the suturing of a fully dilated vessel, intracoronary papaverine is injected into the cl amped aortic root while the heart is still beating and before systemic cooling begins. The suturing technique applies some microvascular pri nciples, the chief being a high number of stitches incorporating the l east amount of tissue, to avoid bulk.