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Eur J Cardiothorac Surg 2002;21:953
© 2002 Elsevier Science NL

Letter to the Editor

Reply to Bonnachi et al.

Department of Cardiac Surgery, Centre Cardiologique du Nord, 32–36 rue des Moulins Gémeaux, F-93200 St. Denis, France

Received 6 December 2001; received in revised form 5 February 2002; accepted 6 February 2002.

* Tel.: +33-6-1766-8800; fax: +33-1-4933-4118
e-mail: alattar{at}ifrance.com

We would like to thank Dr Bonacchi for his comments.

Firstly, retrocaval routing of the right internal mammary artery (RIMA) described by Pliam and Zapolanski in 1993 [1] is quite different from what we propose. Pliam indeed passes the RIMA retrocavally below the azygous vein and between the superior vena cava and the right pulmonary artery, the RIMA, then, lies on the roof of left atrium before passing into the transverse sinus. In our technique, the RIMA is passed behind the right subclavian vein and behind the right and left innominate veins well above the azygous vein. We believe that our technique offers a more direct pathway of the RIMA from its origin to the transverse sinus.

We did in fact miss Pliam's paper during our search of the medical literature and despite important differences between our two techniques, we regret this lapse. Nevertheless, having tried Pliam's technique, we strongly believe that our method allows a greater gain of length.

Secondly, we disagree with Dr Bonacchi's comments on lambda grafting with a free end segment of the LIMA in conjunction with our technique, since the RIMA is almost entirely invisible in this routing and the free graft would be far too short to reach the right coronary artery as Bonacchi proposes [2].

On the other hand, we have indeed performed lambda grafting with the radial artery anastomosed on the distal segment of a retrocaval RIMA offering suitable configuration for grafting the right coronary artery and branches.

Finally, our paper was a ‘How-to-do-it’ with the primary objective of explaining a novel technique in its standard and basic form.

We do share Dr Bonacchi's opinion that our proposed routing offers protection of the RIMA in redo surgery but this is not the principal advantage of the technique.

References

1. Pliam M.B., Zapolanski A. Retrocaval routing of the right internal thoracic artery. Ann Thorac Surg 1993;56:181-182.[Abstract]
2. Bonacchi M., Prifti E., Giunti G., Salica A. Right Y graft, a new surgical technique using mammary arteries for total myocardial revascularization. Ann Thorac Surg 2000;70:820-823.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ramadan, R. Search for Related Content PubMed Articles by Ramadan, R. Related Collections Coronary disease