Protection of the patent internal mammary artery by-pass graft from subsequent sternotomy

Objective. We describe a technique to protect the patent internal mammary artery graft from injury by repeat sternotomy. Interventions. The internal mammary artery is dissected as far proximally as possible. The left pleural space is opened widely thus allowing the left lung to protrude through the pleural defect once mechanical ventilation is resumed. The left lung is then interposed between the internal mammary graft and the sternum. The internal mammary artery is thereby-protected from adherence to the sternum and injury upon resternotomy. Results. In two patients in whom this technique was employed repeat sternotomy was easily performed without injury to the internal mammary artery. Conclusions. This simple technique effectively protects the patent internal mammary artery bypass graft from injury at subsequent sternotomy.