Xiphoid Lower-Sternotomy Approach for Multivessel Revascularization of the Left Internal Mammary Artery to the Left Anterior Descending Artery and Right Internal Mammary Artery Inflow to the Other Vessels


  • Federico Benetti
  • Sotirios Prapas
  • Ernesto Angeletti
  • Jose Luis Ameriso
  • Eduardo Cicalle
  • Tomislav Klokocovnik
  • Ivan Knezevic
  • Borut Gersak




Background: We describe the technical details and the preliminary results of a new surgical approach for multivessel disease that involves using a lower T sternotomy, grafting of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) and use of the right internal mammary artery (RIMA) as inflow to the other vessels.

Operative Technique: The sternotomy was made from the xiphoid up to the fourth intercostal space and then was continued transversally (T incision). The LIMA was harvested for a length of approximately 8 cm, with preservation of the distal part. The vein was simultaneously taken from the leg. The RIMA was dissected for a length of approximately 5 cm, and the distal part was occluded. Then, 3 mg/kg heparin was given. The anastomosis between the vein and the RIMA was performed. The distal venous anastomoses were done either singly or sequentially. The anterior or posterior route was chosen according to the patient's anatomy. The LIMA was then anastomosed to the LAD. One drain was placed. The sternum was closed with 4 wires, 2 for the T incision and 2 for the sternum.

Results: Between September and December 2008, 9 patients underwent their operations with this technique. The mean age was 60 years (range, 55-68 years). The mean number of grafts was 2.8. The mean hospital stay was 5.2 days. Operative mortality was 0%. All patients were reevaluated with 16-slice multislice computed tomography, and all grafts were patent. At the 3-month follow-up, all patients were alive and free of symptoms.

Conclusion: This minimally invasive technique is a useful alternative for complete revascularization. The sternal mammary supply and the upper part of the sternum are preserved.


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How to Cite

Benetti, F., Prapas, S., Angeletti, E., Ameriso, J. L., Cicalle, E., Klokocovnik, T., Knezevic, I., & Gersak, B. (2010). Xiphoid Lower-Sternotomy Approach for Multivessel Revascularization of the Left Internal Mammary Artery to the Left Anterior Descending Artery and Right Internal Mammary Artery Inflow to the Other Vessels. The Heart Surgery Forum, 13(1), E36-E39. https://doi.org/10.1532/HSF98.20091131