Microvascular Coronary Artery Repair and Grafting in Infancy and Early Childhood

Pediatric coronary bypass grafting requires special technical consideration and microsurgical techniques, including appropriately fine instruments, 10-0 or 11-0 microsutures, and repair under an operating microscope. At The Hospital for Sick Children, the Divisions of Cardiac and Plastic and Reconstructive Surgery have utilized the expertise of both specialties to address technical concerns during pediatric coronary bypass grafting. We anastomose the left internal mammary artery to the left anterior descending artery with the use of an operating microscope and 10-0 Nylon sutures. Here we describe our surgical technique as well as our perioperative, and postoperative protocols. Patients must be monitored closely postoperatively for edema, thrombosis, infection, and bleeding, which can compromise the patency of the anastomosis.