[Minimally invasive direct coronary artery bypass performed via diaphragmatic approach].

From October 1996 until August 2000, coronary artery bypass grafting (CABG) for right coronary artery was performed via diaphragmatic approach. This procedure was done in 18 patients consist of 13 male and 5 female ranging in age from 47 to 81 years old. Ten of 18 cases were performed coronary bypass reoperation. Right gastroepiploic artery was used in 16 cases, and branched radial artery or saphenous vein graft from gastroduodenal artery was used in one case. Bypassed region in right coronary artery was segment 3 in 9 cases, right posterior descending artery in 8 and right atrio-ventricular branch in one. All grafts were patent in postoperative cardiac catheterization. This approach was desirable for the case, which bypass grafting to right coronary artery is necessary, on account of avoiding injury of patent bypassed graft by median sternotomy in re-do CABG. For the patient whose stomach had been resected, bypass grafting from gastroduodenal artery with radial artery or saphenous vein graft to right coronary artery is useful procedure.