Categories: Cardiac Surgery

Total Arterial Revascularization using RIMA LIMA Y

Thousands of patients undergo a Bypass Surgery (CABG) in India every year. It is performed to bypass the blocked or narrowed arteries that supply blood to the heart. The bypass is created by using a blood vessel (graft) which can be an artery or vein removed from another part of the body and grafting it across the blockage, to restore blood flow to the heart.

In bypass surgery, the technical skills & expertise of the operating surgeon is paramount. The success of the surgery also depends on the long-term patency (or life) of the grafts used, it’s quality, and whether it is a live graft that can respond to the body’s demands.

Traditional Bypass Surgery Vs. Bypass Surgery using RIMA LIMA Y grafts:

Generally, in bypass surgery, the saphenous vein from the leg or radial artery from the arm are used as grafts. However, as per several studies, these grafts are prone to degeneration and blockages. Also, just like synthetic grafts, they cannot respond to the needs of the body. In the Total Arterial Revascularization technique of Bypass Surgery, the internal mammary arteries (LIMA & RIMA) from the left and right sides of the chest respectively are used. Internal Mammary Artery grafts are considered the best conduits – these grafts are long-lasting, resistant to cholesterol blockages, can change as per the body’s demands, and are also capable of self-repair.

So how long does a Bypass Surgery last?

As per several studies, if a patient undergoes Bypass Surgery using Mammary Artery as grafts, then approximately 95% LIMA grafts (source: and 90% RIMA grafts are likely to remain open and working even 10 years after the operation. In cases where saphenous vein graft is used, 40%-50% of vein grafts are likely to get blocked within 10 years of bypass surgery – requiring a re-intervention or a re-operation.

Advantages of using Internal Mammary Artery Grafts:

  • Patency of the life of arterial graft very high which translates to Improved life expectancy amongst patients.
  • Chances of recurrence of blockage are minimized because these grafts are highly resistant to fact & cholesterol build-up (atheroma).
  • Cosmetically better – no scars in hands or legs.
  • It does not involve the main heart vessel (Aorta), hence prevents its associated complications like Brain Stroke.

The fact that Total Arterial Revascularization technique is technically very demanding and time-consuming, it is regularly performed at very few heart centers and by a select few cardiac surgeons. This technique is completely safe & effective for diabetics & patients with multiple blockages. Total arterial revascularization using the LIMA RIMA Y technique is considered as the gold standard of Bypass Surgery.

Dr. CP Srivastava, Director & Chief Consultant Cardiac Surgery – Adult, Cardiac Surgery – Paediatric, Narayana Multispeciality Hospital, Jaipur

Narayana Health

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