Surgical Technique
All CABG procedures were performed by the same surgical team in a standardized fashion utilizing an on-pump technique. Arterial and venous catheters were inserted into the radial artery and right jugular vein before sternotomy. Blood pressure, central venous pressure, urine output and oxygenation were monitored throughout the surgery. All patients underwent standard median sternotomy under general anesthesia. Grafts were prepared after heparinization (300 IU/kg). After placement of the Favalaro retractor, LIMAs were harvested in the form of pedunculated grafts in all patients by the use of electrocautery and hemoclips. During and after harvesting of LIMAs, a warm papaverine solution was used to prevent LIMA spasm. Following the performance of side-to-side LIMA and SVG anastomosis, coronary flow in the distal LAD was checked and side-to-end LIMA-LAD artery anastomosis was carried out using 8-0 prolene sutures. Saphenous Vein Grafts (SVGs) were harvested endoscopically and were grafted to the coronary arteries by employing the end-to-side anastomotic technique. An epicardial pacing wire was then positioned on the anterior cardiac surface and mediastinal and thoracic cannulas were placed for drainage. The sternum was closed by surgical steel wires as a complete layer. 4-0 vicryl was used for skin and subcuticular closure. Following the operation, patients were transferred to the intensive care unit (ICU) and received enoxaparin 0.1 mg/kg twice daily for three days. From the first postoperative day, all patients received a lifelong daily maintenance dose of 100 mg of aspirin.