Creation of Composite Y-graft with Bilateral Internal Mammary Arteries for Coronary Grafting

This video shows the technique of composite Y-graft creation with internal mammary arteries (IMA) for bilateral IMA coronary grafting operation. This is performed before going on bypass.
Right internal mammary artery (RIMA) is harvested as a skeletonized free graft and left internal mammary artery (LIMA) is harvested as a skeletonized pedicled graft. The skeletonization is important to provide a good length of the grafts and avoid sternal infection.
Since the heart is full and not arrested the precise marking of the Y-graft anastomosis site on the LIMA is possible. This site is marked on the LIMA at the level of left atrial appendage. The proximal end of right IMA is anastomosed to the marked site of the left IMA (end-to-side anastomosis) using continuous 8-0 Prolene suture.
The blood flow in the Y-graft is measured to make sure that it is about 3 times more than the flow in the LIMA (measured before) to be able to provide good blood supply to 2 and more coronary arteries bypassed.
The composite Y-graft is now ready for BIMA coronary grafting.