Coronary artery bypass via diaphragmatic approach with free graft

To avoid injury to patent bypass grafts or myocardium during median sternotomy in coronary artery bypass graft reoperation, we performed modified minimally invasive direct coronary artery bypass to the right coronary artery via diaphragmatic approach using the right gastroepiproic artery. In cases in which the right gastroepiproic artery cannot be used, this technique is performed with a free graft from the gastroduodenal artery. This approach is very useful for reoperation in these circumstances.