Less Invasive Direct Coronary Artery Bypass Grafting Using H Graft for a Patient with Advanced Prostatic Cancer

Satoru Nishida, MD,1 Tamotsu Yasuda, MD,1 Go Watanabe, MD,1,2 Taro Kanamori, MD,1 Yujiro Kikuchi, MD,1 and Shigeki Ito, MD1

Minimally invasive direct coronary artery bypass grafting (MIDCAB) using an H graft was performed on a 74-year-old man with advanced prostatic cancer who needed coronary revascularization. Through a left anterior small thoracotomy, the left internal thoracic artery (LITA) and the left anterior descending artery (LAD) were cleared, and a short radial artery (RA) was placed in an end-to-side fashion between the LITA and LAD. The distal LITA was ligated to avoid potential steal phenomenon. A flow pattern through the RA graft evaluated by transit time flow measurements demonstrated good diastolic flow with a mean value of 37 mL/min. The total surgical duration was 80 min, and no blood products were required. A postoperative angiogram showed a widely patent H graft. The patient was relieved of chest pain and was discharged. The H graft procedure is a useful alternative technique to minimize the surgical trauma in limited situations such as a high-risk case. (Ann Thorac Cardiovasc Surg 2007; 13: 278-281)

Key words: H graft, minimally invasive direct coronary artery bypass grafting

1Division of Cardiac Surgery, Tokyo Medical University, Tokyo, and 2Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan

Received November 9, 2006; accepted for publication December 15, 2006
Address reprint requests to Satoru Nishida, MD: Division of Cardiac Surgery, Tokyo Medical University, 6–7–1 Nishishinjuku, Shinjuku-ku, Tokyo 160–0023, Japan.