Coronary bypass after ascending aorta to femoral graft placement running head: CABG after ascending aorta-bifemoral graft.

A 73-year-old woman had undergone ascending aorta-bifemoral bypass 9 years previously and now required coronary artery bypass for unstable angina. The technical considerations for the operation had never been described. We successfully completed the operation by mobilization of the pre-existent graft as it exited the thorax and by intermittent aortic root perfusion of the graft. Postoperatively she had no lower extremity complications, despite what was likely a graft dependent circulation. The same technique for coronary bypass can likely be used for all extra-anatomic bypass grafts originating from the ascending aorta. An alternate theoretical method is also discussed.