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(A) Harvested right gastroepiploic artery (RGEA). (B) The transdiaphragmatic exploration of the right coronary artery (RCA) and the RGEA was anastomosed to the RCA on the beating heart. (C) Repair of the abdominal aortic aneurysm with the collagen-impregnated Dacron graft.
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After the left paramedian incision was made and the peritoneum was opened, we created a passage at the front part of the diaphragm with electrocautery to inspect the RCA and to determine if revascularization was appropriate. After the RGEA was harvested for the transdiaphragmatic exploration of the RCA, the front part of the diaphragm and both arcus costalis were retracted using a sternal retractor (Figure 1A). The RGEA was anastomosed to the RCA on the beating heart using an Octopus4 tissue stabilizer (Medtronic, Inc, Minneapolis, MN, USA) (Figure 1B). After CABG, the aneurysm was excised and circulation was re-established using a collagen-impregnated Dacron graft (20 mm) (Figure 1C).
Computed tomography angiography showing that the coronary anastomosis was patent in the first month of follow-up period.
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No complications were observed during the early or late postoperative period, and CT angiography revealed that the anastomosis was patent in the first month of follow-up (Figure 2).