Comparative Analysis of Bilateral Internal Mammary Artery Configurations with a Novel Hemoclip Anchoring Technique
Fatih Kızılyel
, Bedirhan Buğra Bayıcı, Murat Bülent Rabuş
Department of Cardiovascular Surgery, University of Health Sciences, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
Keywords: Coronary artery bypass grafting; internal mammary-coronary artery anastomosis; mammary arteries.
Abstract
Objective: Bilateral internal mammary artery (BIMA) grafting improves long-term survival in coronary artery bypass grafting (CABG). Although the left internal mammary artery (LIMA) is routinely used for the left anterior descending artery (LAD), in-situ right internal mammary artery (RIMA) grafting is less frequently preferred due to concerns regarding graft tension and insufficient length. This study compared perioperative outcomes of LIMA–LAD and RIMA–LAD grafting and evaluated the feasibility of a novel hemoclip anchoring technique designed to predict RIMA graft stress before LAD anastomosis.
Methods: Between January 2023 and September 2025, 40 patients underwent CABG with BIMA grafting at our center. Twenty-two patients received LIMA–LAD (Group 1), and 18 patients underwent RIMA–LAD using the hemoclip anchoring technique (Group 2). Pre-operative characteristics, intraoperative variables, post-operative hemodynamics, biochemical markers, and early outcomes were analyzed retrospectively.
Results: Baseline demographics and comorbidities were comparable between groups (all p>0.05). The number of distal anastomoses, cardiopulmonary bypass times, and cross-clamp durations were similar. Post-operative hemodynamic support requirements (intra-aortic balloon pump 9% vs. 6%; extracorporeal membrane oxygenation 4.5% vs. 6%), myocardial injury markers (troponin 380±110 vs. 365±105 ng/L), and lactate levels showed no significant differences. No graft-related intraoperative complications occurred. Early post-operative outcomes – including atrial fibrillation, re-exploration, sternal wound complications, mortality, and length of stay – were also similar. All patients were asymptomatic at 3-month follow-up.
Conclusion: The hemoclip anchoring technique provides a simple, reproducible, and safe method for pre-anastomotic assessment of RIMA geometry, enabling tension-free in-situ RIMA-to-LAD grafting. Perioperative outcomes were equivalent to conventional LIMA-to-LAD grafting. Larger studies with long-term follow-up are warranted.
Cite This Article: Kızılyel F, Bayıcı BB, Rabuş MB. Comparative Analysis of Bilateral Internal Mammary Artery Configurations with a Novel Hemoclip Anchoring Technique. Koşuyolu Heart J 2026;29(1):21–25