Modified pericardial closure to protect internal mammary artery grafts in coronary artery bypass

Redo operations after coronary artery bypass surgery have been on the rise, and myocardial and graft injury during resternotomy a catastrophe. Closure of pericardium after a traditional midline incision may lead to graft distortion. In this report, we will describe a technique of pericardial closure and thymus coverage to protect bilateral internal mammary artery grafts from damage.