A novel approach to coronary revascularization in patients with severely diseased aorta

Atheromatous disease of the aorta significantly increases morbidity and mor tality during coronary revascularization. The surgical approach must be mod ified for patients in whom this condition is identified. In this report we describe a technique that uses bilateral internal thoracic arteries as comp osite grafts with reverse saphenous veins. The operation is performed witho ut cardiopulmonary bypass. We report the cases of 2 patients who underwent this procedure. Neither patient experienced signs or symptoms of atheromato us embolization, and there was no perioperative morbidity or mortality. Off -pump myocardial revascularization using bilateral internal thoracic arteri es is an attractive surgical approach for patients who have atheromatous ao rtas or other conditions in which it is advantageous to avoid aortic manipu lation, cannulation, cross-clamping, and cardiopulmonary bypass.