This paper reports our experience with the use of compound grafts in minimally invasive coronary artery bypass graft (MICABG). An alternative for MICABG is the use of compound grafts in cases where several coronary branches are to be revascularized, when internal mammary artery is demonstrated to be short, or branches off early. One female patient, 54 years old, with a lesion of 90% in the third proximal part of the left descending artery (LAD), was operated upon, submitted to MICABG by left rainithoracotomy. The left internal mammary artery (LIMA) was amply dissected by the use of a long electrocautery, with the help of a videothoracoscope, and a clip for ligation of the intercostal branches. Following the sectioning of the LIMA, there was absence of blood flow and technical problems at the distal third. This compromised segment was disposed off and the LIMA was lengthened using the interpositioning of a saphenous vein segment, making possible the anastomosis with the LAD. Surgery was three hours long and the patient extubated fours hours postoperatively; the left pleural drainage tube was removed on the third day. Patient follow-up was satisfactory, without clinical problems; patient left the hospital in the fifth postoperative day. Postoperative cineangiocoronariography showed anastomosis patency; echodopplercardiogram performed on the fourth postoperative month showed patency and high resistence flow. In conclusion, the use of compound grafts for MICABG showed to be an efficient alternative to amplify the extension of the LIMA, enabling anastomosis when this artery is short or presents flow problems, or even if there is intention of treating more than one coronary artery.
Myocardial revascularization; Thoracic arteries; Coronary vessels; Thoracoscopy; Surgery, minimally invasive