Reoperative grafting of the LAD system using the LAST approach: Technical details

In patients in whom the left internal mammary artery (LIMA) has been previo usly utilized, reoperative grafting of the left anterior descending (LAD) o r diagonal coronary arteries can be performed through a left anterior small thoracotomy (LAST) approach, utilizing the subclavian artery as inflow sou rce. In such cases, however, the left upper lobe of the lung and the lingul a may exert unwanted traction on the newly constructed coronary graft. Here in, we describe a detail of technique that eliminates this inconvenience.