Coronary Arteriotomy

Coronary arteriotomy is utilized for coronary artery bypass grafting or, less frequently, coronary endarterectomy. The site of the arteriotomy is primarily dictated by the location of the stenotic or occlusive lesion, which can be determined by preoperative imaging in conjunction with manual intraoperative palpation. In general, ideal arteriotomy sites are distal to the stenosis or occlusion, epicardial, and devoid of tortuosity or gross disease.The circumference and geometry of the arteriotomy should correspond to bypass conduit measurements, ie, small and large conduit lumens necessitate small and large arteriotomies, respectively. The bypass conduit should be distended during these measurements to simulate in vivo dimensions. A fresh #15C scalpel blade should be utilized for each separate arteriotomy, and cardiac movement should be minimized during all incisions. The scalpel blade is positioned at a 45-degree angle to the tangent of the vessel circumference, and a longitudinal incision is made at the vessel midline. Coronary probes can be used to confirm entrance into the vessel lumen. The arteriotomy is then extended proximally and distally to accommodate the bypass conduit measurements. Although complications are rare during coronary arteriotomies, care must be taken to avoid coronary artery dissection as well as perforation of the posterior vessel wall.Suggested ReadingAlexander JH, Smith PK. Coronary-artery bypass grafting. N Engl J Med. 2016;374(20):1954-1964.Martinez-Gonzalez B, Reyes-Hernandez CG, Quiroga-Garza A, et al. Conduits used in coronary artery bypass grafting: a review of morphological studies. Ann Thorac Cardiovasc Surg. 2017;23(2):55-65.Ischemic Heart Disease. In: Chikwe J, Cooke DT, Weiss A. Cardiothoracic Surgery (Oxford Specialist Handbooks in Surgery). 2nd ed. Oxford, England: Oxford University Press; 2013: 324-335.Ischemic Heart Disease. In: Doty DB, Doty JR. Cardiac Surgery: Operative Technique. 2nd ed. Philadelphia, PA: Saunders, an imprint of Elsevier; 2012: 393-431.