Key result
Wide unilateral sternal retraction can cause upper rib fractures that compromise LIMA graft flow.
Why the study?
The internal mammary artery is the primary conduit for coronary revascularization, making reliable intraoperative flow assessment indispensable, yet left IMA graft flow can rarely be compromised by sternal manipulation rather than conduit or anastomotic issues.
Case Report (n=1)
No
Answers are grounded in this paper and cite their sources.
Clinicians should consider retraction artifacts during intraoperative graft assessment; this case leaves open dynamic thoracic outlet contributions to ischemia.
Background The internal mammary artery (IMA) is the primary conduit for coronary revascularization, making reliable intraoperative flow assessment indispensable. We describe a rare case in which left IMA (LIMA) graft flow was compromised not by conduit or anastomotic issues but by sternal manipulation. Case summary A 76-year-old man undergoing emergency coronary artery bypass surgery reproducibly demonstrated markedly reduced LIMA flow only during wide sternal retraction. Intraoperatively, pronounced unilateral sternal retraction was noted, and postoperative computed tomography confirmed first- and second-rib fractures. Discussion These findings suggest a dynamic, retraction-dependent inflow disturbance, possibly related to deformation of the thoracic outlet and proximal subclavian artery. This case underscores the need for careful sternal manipulation, which may help avoid unnecessary graft revision or conduit replacement.
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Umeda et al. (2026) conducted a case report in Emergency coronary artery bypass surgery with sternal retraction–induced internal mammary artery graft flow impairment (n=1). Wide unilateral sternal retraction during coronary artery bypass surgery was evaluated on Left internal mammary artery (LIMA) graft flow. Wide unilateral sternal retraction during emergency CABG in 1 patient (76-year-old male) caused first- and second-rib fractures and reproducibly reduced LIMA graft flow.
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