Modified Procedure of Minimally Invasive Direct Coronary Artery Bypass Grafting Using the Left Internal Thoracic Artery — Radial Artery Composite Graft

Introduction:

Minimally invasive direct coronary artery bypass grafting (MIDCAB) procedure has been widespread for surgical revasculization of the left ventricle, and it has benefits such as small surgical wound and avoidance of cardiopulmonary bypass. However, full mobilization of left internal thoracic artery (LITA) through the limited small thoracotomy is very difficult, and there is the risk of LITA injury when it is harvesting. To avoid a LITA injury, we made a LITA-Radial artery (RA) composite graft and performed a LITA-left anterior descending (LAD) artery bypass. This procedure consists of the following concepts: (1) LITA dissection should be minimized to avoid injury. (2) Adequate bypass graft length can be obtained with extension conduit using RA. (3) Arterial graft should be used if possible.

We herewith introduce the surgical technique of this procedure and report the surgical results with 7 consecutive patients.

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