Minimally Invasive Redo-Coronary Artery Bypass Grafting to the Left Anterior Descending Artery

Reoperation in cardiac surgery is associated with increased morbidity and mortality. The proximity of cardiovascular structures such as the right ventricle, aorta, and/or grafts to the posterior table of the sternum increases the risk of inadvertent injury. Here, we present the case of a 71-year-old gentleman who was admitted with exertional angina (Canadian Cardiovascular Society III/IV) following coronary artery bypass graft over 30 years ago. Coronary angiogram demonstrated an atretic chronically occluded left internal thoracic artery graft and an acutely occluded saphenous vein graft, and computed tomography revealed that the right ventricle and pulmonary artery were closely adherent to the posterior table of the sternum. We outline a minimally invasive approach to ensure arterial revascularization of the left anterior descending artery while avoiding high-risk resternotomy, cardiopulmonary bypass, and aortic manipulation.