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eComment: No need to open the upper part of the sternum to measure the length of the left internal mammary artery

Benetti Foundation, Alem 1846, Rosario 2000, Argentina

Left internal thoracic artery harvesting: measurement of the length required for coronary bypass surgery

I agree with the authors about the importance of adjusting the length of the left internal thoracic artery (LITA) to avoid graft kinking. I also agree that preserving the distal segment of both LITA and right internal thoracic artery (RITA) as much as possible is important to prevent wound healing complications [1].

We described a technique [2–4] were we dissect approximately 7 to 8 cm of the LITA and cut the distal mammary 1 to 2 cm before the bifurcation (xiphoid approach-lower sternotomy). The left internal mammary artery (LIMA) is anastomosed to any segment of the left anterior descending aorta (LAD). At this moment we are performing this operation in multiple grafts, generally LIMA to LAD and other conduits, vein or arteries using the RIMA as inflow and preserving the distal part of the mammary as much as possible. At 110 months of follow-up of the initial series of patients with this technique we did not observe any complications in wound healing [5].

In conclusion you do not need to open the upper part of the sternum to measure the length of the LITA required for coronary surgery or to preserve the distal part of the LITA or RITA [1]. Also, preserving the upper part of the sternum is important in case the patient will need a future intervention in the aortic valve.

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1. Gwozdzienicz M. Left internal thoracic artery harvesting: measurement of the length required for coronary bypass surgery. Interact CardioVasc Thorac Surg 2008;7:1160–1161.[Abstract/Free Full Text]
2. Benetti FJ. Minimally invasive coronary surgery, Seventieth Scientific Sessions of the American Heart Association, Orlando, FL, USA. 1997.
3. Benetti FJ. Minimally invasive coronary surgery (the xiphoid approach). Eur J Cardiothorac Surg 1999;16(Suppl_2):S10–S11.[Free Full Text]
4. Minimally invasive cardiac surgery, Second Edition, Goldstein DJ, Oz MC, Chapter 11.
5. Benetti FJ, Rizzardi JL, Concetti C, Angeletti E, Patel A, Benetti IM, Zappetti A, Bergese M. Xiphoid approach long term results. 18th World Congress – World Society of Cardio-Thoracic Surgeons Kos Island, Greece April 30–May 3, 2008. Heart Surg Forum 2008;11(Suppl 1.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Federico Benetti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Benetti, F. Search for Related Content PubMed PubMed Citation Articles by Benetti, F. Related Collections Related Article