ONLINE COURSE ON CORONARY ANASTOMOSES TECHNIQUES
Prof. Sidney Chocron, University Hospital, Besançon, France.

Coronary revascularisation is the field of cardiac surgery aiming at providing enough blood flow to coronary vessels. Native blood flow is restricted by the narrowing or the occlusion of the coronary arteries due to atheroma. To provide blood flow, grafts need to be sutured to native coronary vessels below the diseased segment. To date, the best graft known are the mammary arteries.
Suture techniques enable surgeons to use graft length so as to perform complete mammary revascularisation. Suture techniques vary depending on the location of the coronary artery, the number of arteries to bypass, and the graft length available.

This video is an introduction to the course.

This video is part of an online course on coronary anastomosis composed of 15 videos (existing in English and French versions) reviewing the different existing techniques of coronary anastomosis.

First presenting the interests of complete mammary revacularisation, this course will be successively focused on:
• The technique of mammary harvesting
• The techniques to expose the coronary vessel that will be grafted.
• How to do a Y anastomosis, i.e, an anastomosis between the right and the left mammary artery
• How to do the end-to-side anastomosis in a classical and in a diamond shaped manner
• How to do the side-to-side anastomosis,which can be :
o Classical
o Diamond-Shaped
o Inverted Diamond-Shaped
• The combination of the different techniques to achieve complete mammary revascularisation.
• The course ends with a presentation of control coronary angiograms.

DEFINITIONS
o An End-to-Side anastomosis is an anastomosis between the end of the gaft and the side of the native coronary artery.
o A Side-to-Side anastomosis is an anastomosis between the side of the gaft and the side of the native coronary artery. It enables to bypass numerous vessels with one single graft.
o An anastomosis is called « CLASSICAL » if the graft and the native coronary artery are parallel. When performing the anastomosis, the heel of the graft corresponds to the heel of the native coronary artery.
o An anastomosis is called « DIAMOND-SHAPED » if the graft and the native coronary artery are perpendicular. When performing the anastomosis, the heel of the graft corresponds to the side of the native coronary artery.
o An anastomosis is called « INVERTED DIAMOND-SHAPED » if the graft opening is perpendicular to the big axis of the graft. When performing the anastomosis, the heel of the graft corresponds to the heel of the native coronary artery, but once the anastomosis is performed, the graft is perpendicular to the native coronary artery due to the axis of the opening.