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

Atheromatous disease of the aorta significantly increases morbidity and mortality during coronary revascularization. The surgical approach must be modified for patients in whom this condition is identified. In this report, we describe a technique that uses bilateral internal thoracic arteries as composite grafts with reverse saphenous veins. The operation is performed without cardiopulmonary bypass. We report the cases of 2 patients who underwent this procedure. Neither patient experienced signs or symptoms of atheromatous embolization, and there was no perioperative morbidity or mortality. Off-pump myocardial revascularization using bilateral internal thoracic arteries is an attractive surgical approach for patients who have atheromatous aortas or other conditions in which it is advantageous to avoid aortic manipulation, cannulation, cross-clamping, and cardiopulmonary bypass.