Extrapleural harvesting of the mammary artery in the costodiaphragmatic sulcus.

In coronary artery bypass surgery the most commonly used conduit for grafting the left anterior descending artery is the left internal mammary artery. In harvesting the internal mammary artery the parietal pleura is frequently breached. This is associated with increased post operative complications. The diaphragm is not in contact with the parietal pleura anteriorly. The risk of opening the pleura is considerably reduced if the costodiaphragmatic sulcus is developed first. If more cardiac surgeons were aware of the potential of the costodiaphragmatic sulcus then some of the complications associated with coronary artery surgery could be reduced.