Objective: to show our experience at reoperation after coronary bypass surgery through minimally thoracic access.

Patient K, 69 years old, male.

Diagnosis: Ischemic Heart Disease. Angina pectoris. 4 functional class.

Condition after coronary bypass operation (2 autovenous bypasses 2015). Implantation coronary stents 2007, 2009, 2019, 2024 years.

Hypertension, stage 3. Diabetes mellitus type 2.

Complaints: pain in retrosternal area, feeling of lack of air with little physical activity (when moving a distance of 50-80 m), shortness of breath, fatigue, general weakness.

History of illness: Patient has been suffering from coronary heart disease and hypertension for many years, the blood pressure is a maximum of 180 mm Hg. He has received regular inpatient and outpatient treatment.

According to the medical history, in 2007, 2009, 2019, 2024 years he underwent balloon angioplasty and stenting of coronary vessels, and in 2015 he underwent coronary bypass surgery (2 bypasses). After balloon angioplasty performed in 2019, the patient's condition has been stable over the past 2 years.

Over the past 6 months, there has been a resumption of angina pectoris. By this means, there was performed angio-shuntography.

Coronaryangiography: left coronary artery intact. LAD at proximal part has previously installed stent with instent stenosis, Cx artery has previously installed stent with instent stenosis. RCA is occluded, the distal part is contrasting due to intersystem collaterals. Shuntography – autovenous shunts to the LAD and Cx are patent.

General condition of the patient is moderate. Heart sounds are clear, rhythmic, heartbeat 80 times per minute. When examined, blood pressure is higher than 130/80 mm Hg. SpO2=98%.

ECG: Sinus rhythm, heart rate: 63bpm. Dystrophic changes in the myocardium

EchoCG: EDV 100 ml. EF 48%.

November 27, 2024. OPERATION. Great saphenous vein to RCA on a beating heart CABG through right minithoractomy (MIDCAB).

The postoperative period was stable. The patient was discharged from the clinic on the 6th day.

Conclusion: in the presence of an increased risk due to access through a median sternotomy, performing coronary artery bypass graft surgery from a minithoracotomy approach is a safe method that has a beneficial effect on the outcome of the operation.