Inverted graft insertion technique for apicoaortic bypass.

The proximal anastomosis of the apicoarotic bypass is technically demanding. We describe our novel surgical technique to reinforce the proximal anastomosis of the apicoaortic bypass. After moving circular muscle of the left ventricle (LV) under ventricular fibrillation, an inverted tube graft is inserted into LV through the opening of the apex. Then, end-to-end anastomosis is made with horizontal mattress sutures passing from the inside of the inverted tube graft through the entire thickness of LV muscle and a running suture of the edge of LV muscle and graft. As the tube graft is pulled out from the LV, the anastomosis is completed. This technique permits simple and reliable suture placement without the need for any special device for the proximal anastomosis of the apicoaortic bypass.