Double-vessel revascularization using a composite graft approached from small left thoracotomy

Minimally invasive direct coronary artery bypass usually includes single vessel revascularization via a small skin incision. In most cases, the left internal mammary artery has been used for bypassing to the left anterior descending artery, and only single vessel revascularization used to be performed due to the limited operating field. We present 2 cases of successful double-vessel revascularization approached from a left small thoracotomy, using a composite graft of the internal mammary artery and the inferior epigastric artery, anastomosing to the left anterior descending artery and diagonal artery.