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Composite Coronary Bypass Using 'no-touch' Vein Grafts And Internal Mammary Artery: A Novel Approach To Aorta-free Revascularization
Aleksandar V. MIlutinovic1, Matija Furtula
2, Andjelka Pavasovic
3, Nemanja Milosevic
2, Dragana Radoicic
2.
1University Children's Hospital, Belgrade, Serbia,
2Institute of Cardiovascular Diseases Dedinje, Belgrade, Serbia,
3City Institute for Emergency Medical Services Belgrade, Belgrade, Serbia.
OBJECTIVE:The aim of this study is to present and evaluate an innovative approach to coronary revascularization using “No-Touch” saphenous vein grafts in combination with the left internal mammary artery (LIMA) in composite configurations, completely avoiding aortic manipulation. This technique aims to improve graft patency, minimize perioperative complications, and increase long-term durability, especially in technically demanding clinical scenarios.
METHODS:Between 2021 and 2024, six patients underwent composite coronary artery bypass grafting using “No-Touch” vein grafts and LIMA without any aortic manipulation. The graft configuration included sequential and coronary-to-coronary anastomoses, optimizing conduit length and minimizing the risk of embolic complications. The preserved perivascular tissue in “No-Touch” grafts provided natural external support, reducing kinking and improving intraoperative handling.
RESULTS:All patients remained angina-free with no signs of myocardial ischemia during follow-up. Five out of six underwent MSCT or coronary angiography between 6 and 12 months postoperatively, confirming graft patency and good runoff. No intraoperative or postoperative complications were observed, and no neurological events were recorded. Although intraoperative flow measurements were not routinely used, clinical and imaging findings confirmed adequate graft function.
CONCLUSIONS:The use of “No-Touch” vein grafts in combination with LIMA in composite coronary configurations represents a feasible, safe, and effective alternative to conventional techniques, particularly in patients where aortic manipulation is undesirable or contraindicated. This approach offers a valuable option for complex coronary revascularization, including in cases of porcelain aorta, combined procedures, or minimally invasive surgery, and has the potential for broader application in routine surgical practice.
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