Minimally Invasive Redo Coronary Artery Bypass to Right Coronary Artery With Right Gastroepiploic Artery

Redo coronary artery bypass grafting (redo CABG) is a challenging procedure because surgical access must be reestablished, patent grafts must be preserved, and arterial graft selection is limited. We managed the case of a 58-year-old man with a history of prior CABG and end-stage renal disease in whom non-ST-segment elevation myocardial infarction developed as a result of severe in-stent restenosis of the mid right coronary artery. Coronary angiography demonstrated patent grafts, including left internal mammary to left anterior descending. To mitigate redo CABG risks, this patient underwent a sternotomy-sparing, off-pump, redo CABG by a gastroepiploic artery to posterior descending artery anastomosis through a minimally invasive subxiphoid approach.