Extracorporeal Right Internal Mammary Artery to Radial Graft for Minimally Invasive Total Arterial Coronary Bypass

Total arterial revascularization (TAR) may improve outcomes in coronary artery bypass grafting. However, the complexity of using in situ right internal mammary artery (RIMA), particularly in minimally invasive coronary artery bypass grafting, has limited adoption. We describe in situ RIMA extracorporeal extension using a radial conduit. This minimally invasive approach facilitates off-pump, anaortic TAR. The RIMA is harvested with a harmonic scalpel and right lung retraction. It is exteriorized by a 10-mm trocar in the first or second intercostal space and anastomosed to the radial artery. This has been repeatedly applied without complication. It addresses RIMA length and access limitations, broadening sternal-sparing TAR approaches.