Modification of repeat coronary bypass grafting for the left anterior descending artery with a minimally invasive direct coronary artery bypass technique

BACKGROUND: The usefulness of minimally invasive direct coronary artery bypass (MIDCAB) for reducing mortality and morbidity associated with repeat coronary artery bypass grafting (re-CABG) has been reported. In re-CABG, graft selection and operative procedures are determined according to the previous mode of CABG. METHODS: We performed three types of operations using MIDCAB techniques for rerevascularization of the left anterior descending artery (LAD) using (1) the in situ left internal thoracic artery, (2) the in situ right gastroepiploic artery, and (3) a reversed saphenous vein graft anastomosed to the left axillary artery. RESULTS: In all cases, the postoperative course was uneventful. None of the patients had any symptom of ischemia postoperatively. CONCLUSIONS: In re-CABG for rerevascularization of LAD, a modified MIDCAB technique using one of the above three procedures should be considered.