Minimally invasive direct coronary artery bypass in a cardiac transplant recipient with allograft vasculopathy.

Coronary bypass operation with cardiopulmonary bypass has provided disappointing results for the treatment of cardiac allograft vasculopathy (CAV). We describe a 61-year-old man who underwent heart transplantation for secondary dilated cardiomyopathy in 1995. Consecutively, CAV developed with clinically silent left anterior descending occlusion. After angiographic diagnosis in 1998 he successfully underwent a minimally invasive direct coronary artery bypass procedure. Annual coronary angiography showed a patent left internal mammary to left anterior descending bypass graft more than 4 years after operation. In select cases, minimally invasive direct coronary artery bypass is a therapeutic option for the treatment of CAV.