# Triple Arterial Minimally Invasive Direct Coronary Artery Bypass Grafting: Step-By-Step Technique Report

## TL;DR

This paper describes a minimally invasive heart surgery technique using three arteries to bypass blocked coronary arteries in a patient with multiple heart issues.

## Contribution

The novel contribution is a detailed step-by-step technique for MIDCAB using triple arterial grafts and four anastomoses.

## Key findings

- A successful MIDCAB procedure was performed using triple arterial grafts.
- The technique involved four arterial anastomoses including a 'jumping' graft configuration.
- The procedure was applied to a patient with multivessel coronary disease.

## Abstract

Minimally invasive direct coronary artery bypass grafting (MIDCAB) has
considerable benefits over the conventional coronary artery bypass grafting
procedure. This case report presents the MIDCAB procedure in a multivessel
coronary disease using triple arterial grafts and four arterial anastomoses. The
initial anastomosis was made between the left intrathoracic mammary artery
(LIMA) and the radial artery (RA), as an end-to-side "T" graft. Next, the RIMA
was used to left anterior descending anastomosis. The first obtuse marginal
(OM1) branch was grafted to allow LIMA-OM1 side-to-side anastomosis. Then, with
the diagonal branch (Dg) opened, the formation of a "jumping" anastomosis was
made using LIMA-OM1-Dg. The posterior descending artery (PDA) was used to create
a LIMA-RA-PDA.