Retrocaval right internal mammary artery for left ventricular marginal arteries grafting.

The retrocaval in situ RIMA is a potential benefit due to blood supply flow advantages, related with grafting both in situ IMAs to the left ventricular coronary arteries. There are no grafts crossing the mid-line behind the sternum, as in cases when RIMA is anastomosed to the left anterior descending artery, which can be considered as an advantage in cases of mediastinal revision or reoperation. The clamping time is reduced due to less proximal anastomoses performed in the ascending aorta and if necessary, the composite grafts may be constructed without extracorporeal circulation. Preserving the pleural integrity, as we usually do during IMA harvesting according to the skeletonized technique, is associated with a better postoperative respiratory function