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Left Subclavian Artery for Graft Inflow in Off-Pump Bypass

In coronary artery bypass grafting without cardiopulmonary bypass, a suitable alternative source of inflow to the free graft is required when the internal thoracic artery has already been used or the ascending aorta is severely atheromatous. Left subclavian artery was used for proximal inflow to a free radial artery graft in 1 patient and to saphenous vein grafts in 3. The free graft was anastomosed to the left subclavian artery through a small subclavian skin incision and the new pedicled graft was introduced into the pleural cavity. Through a left anterior small thoracotomy, the graft was anastomosed to the left anterior descending artery in 3 cases and to the circumflex artery in 1, without cardiopulmonary bypass. The postoperative course was uneventful and all grafts were patent. This technique may extend off-pump coronary artery bypass grafting to patients requiring reoperation and those with a diseased ascending aorta.