Objective: Off-pump coronary artery bypass surgery (OPCAB) has demonstrated to provide reduction of cardiovascular events and mortality. Also the bilateral use of the internal thoracic arteries (ITAs) can offer additional benefits, improving survival. We present the technique of OPCAB using both pedicled ATI grafts, with the right ITA (RITA) routed retro-aortically through the transverse sinus, to revascularize the branches of the circumflex artery (Cx). Method: Twenty-six patients underwent

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... AB with bilateral ATI grafts have been studied, where the left ATI (LITA) was used to revascularize the left anterior descending artery (LAD) and the pedicled RITA, routed through the transverse sinus, anastomosed to the branches of the Cx. Twenty-one patients were male and five female, the age ranging between 42 and 74 years. The morbidities observed in this cohort were previous myocardial infarction in 18 (69%) patients, diabetes mellitus in 10 (38%), renal failure in four (7.7%) and AIDS in one (3.8%) patient. Results: No patient presented ECG changes or enzymatic rise in the postoperative one. The grafts per patient varied from 2 to 4 (average 3.0 grafts/patient). No cases of sternal infection or dehiscence were observed. One patient had a stroke on the 4º PO day and died. The postoperative hospital stay varied between 3 to 12 days (average 5.8 ± 2.0 days). No late deaths or cardiovascular events were recorded. Conclusions: This technique, making possible the offpump grafting of the circumflex artery branches using the pedicled RITA, potentially enhances the benefits of the coronary artery bypass surgery. Descriptors: Myocardial revascularization. Internal mammary-coronary artery anastomosis. Mammary arteries. Extracorporeal circulation Resumo Objetivo: A revascularização miocárdica (RM) sem circulação extracorpórea (CEC) tem demonstrado proporcionar redução da mortalidade e da morbidade. Também o uso bilateral das artérias torácicas internas (ATIs) pode oferecer benefício adicional, conferindo maior sobrevida. Revascularização da artéria marginal com uso da artéria torácica interna direita pediculada retroaórtica sem circulação extracorpórea Off-pump grafting of the circumflex artery with pedicled retro-aortic right internal thoracic artery graft 34 GOMES, WJ ET AL -Off-pump grafting of the circumflex artery with pedicled retro-aortic right internal thoracic artery graft Braz J Cardiovasc Surg 2005; 20(1): 33-38