Vein grafts to left-sided coronary arteries: passage through the transverse sinus.

Vein grafts to left-sided coronary arteries, unlike those to the right coronary artery, do not course and land naturally on an axis parallel to that of the recipient artery. To run such a course, the graft must take off from the aorta in a direction upward and to the left, then loop back toward the left anterior descending, the diagonal, or the circumflex coronary artery. Because of limited space in this area due to the reflection of the pericardium near the left pulmonary artery and left atrial appendage, the vein loop may bend at that point or, when made shorter, may kink at the site of the coronary anastomosis. To avoid the formation of these sharp angulations, the graft may be made to course posteriorly and superiorly into the transverse sinus, behind the main pulmonary artery and the aorta, and may be sutured on the right anterior aspect of the ascending aorta. Following is the description of this technique and its advantages.