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Ann Thorac Surg 2006;82:1919-1921
© 2006 The Society of Thoracic Surgeons

How To Do It

Protecting the Crossover Right Internal Thoracic Artery Bypass Graft With a Pedicled Thymus Flap

Giuseppe Gatti, MD*, Aniello Pappalardo, MD, Livio Gon, MT, Bartolo Zingone, MD, FECTS

Cardiovascular Department, Division of Cardiac Surgery, Ospedali Riuniti di Trieste, Trieste, Italy

Accepted for publication January 12, 2006.

* Address correspondence to Dr Gatti, Cardiovascular Department, Division of Cardiac Surgery, Ospedali Riuniti di Trieste, Ospedale di Cattinara, Polo Cardiologico, Strada di Fiume, 447, Trieste, 34100 Italy. (Email: giusep.gatti{at}tiscali.it).

The right internal thoracic artery graft is placed in jeopardy during repeat sternotomy as it crosses the aorta anteriorly to reach its left-sided coronary targets. We have devised a way of protecting it by means of a pedicled flap taken from the thymic remnants. The flap is easily developed without unduly increasing operative time and morbidity, and it is expected to prevent inadvertent injuries to the graft in the case of mediastinal reentry. Starting in 1999, suitable flaps were obtained in 955 of 1,034 patients (92.4%) receiving an anteaortic crossover right internal thoracic artery-to-coronary graft in our division.






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