Abstract
Reoperative grafting of the left anterior descending (LAD) coronary artery or its diagonal branches can be accomplished through a left anterior small thoracotomy (LAST) on the beating heart using the left internal mammary artery (LIMA) as a conduit. Patients in whom the LIMA has been used previously, however, are generally excluded from this approach unless an alternative technique is utilized. We describe a new technique applicable to these patients that consists of grafting the LAD through a LAST approach and connecting the graft to the right internal mammary artery (RIMA).
