title: A minimally invasive alternative approach for reoperative grafting of the right coronary artery.
abstract: BACKGROUND
  Target vessel revascularization on a beating heart via a mini subxiphoid incision, not only eliminates the hazards of sternal reentry, but also avoids the detrimental systemic effects of extracorporeal circulation.
  
  
  OBJECTIVE
  The goal of the study was to develop and describe a safe and effective method to revascularize the right coronary artery in reoperative cases, using beating heart and minimally invasive techniques in lieu of the RGEA.
  
  
  METHODS
  There were three men and four women with a mean age of 69 years; four were second time reoperations and three third time reoperations. Through a subxiphoid approach, a lower ministernotomy is performed. Once the coronary target is established, a Rultract retractor is used to gently elevate the right half of the sternum to take down the RITA. A mechanical stabilizer was used to provide stabilization for distal anastamoses. Flow was measured in all the grafts with the Medi-Stim before and after protamine administration.
  
  
  RESULTS
  [table: see text]
  
  
  CONCLUSIONS
  We believe that this technique provides another effective approach to the patient who requires reoperative coronary revascularization of the RCA.
authors.affiliation: Division of Cardiothoracic Surgery, State University of New York at Buffalo, New York, USA.
authors.forename: Reginald
authors.initials: R
authors.lastname: Abraham
authors.forename: Marco
authors.initials: M
authors.lastname: Ricci
authors.forename: Tomas
authors.initials: T
authors.lastname: Salerno
authors.forename: Paul
authors.initials: P
authors.lastname: Kerr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000529:Complementary Therapies; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017202:Myocardial Ischemia / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome