Composite LITA-RITA-Y ("LIMA-RIMA-Y") graft configuration for coronary artery bypass grafting

AbstractHide - This Core Skills tutorial elucidates the principal surgical techniques of constructing a composite Y-graft, using the left internal thoracic artery and the right internal thoracic artery, for on-pump coronary artery bypass grafting.

IntroductionHide - More than 50 years after the first left internal thoracic artery (LITA) to left anterior descending (LAD) coronary artery graft [1], it now is the gold standard in revascularization of the anterior left-sided myocardium by coronary artery bypass grafting (CABG) for patients with multivessel coronary artery disease [2].

Despite concerns regarding increased rates of sternal wound complications [3], growing evidence supports the benefits of bilateral internal thoracic artery (BITA) use in selected patients [4, 5]. BITA use in a Y-graft configuration offers the possibility of complete, total arterial revascularization of the ischemic myocardium and avoids side-clamping the aorta. Careful patient selection and meticulous surgical technique play an important role in ensuring the most optimal surgical and clinical outcomes [6].

This high-definition Core Skills tutorial elucidates our preferred main steps of constructing and using BITA in a composite Y-graft configuration during an on-pump CABG procedure.