La cirugía de revascularización por toracotomía izquierda sin circulación extracorpórea, es una alternativa viable en la re-operación de puentes coronarios

background: despite substantial advances in treatment, coronary atherosclerosis is a progressive disease, for this reason a second surgery is frequent. the left anterior small thoracotomy operation on a beating heart is an alternative with less morbidity and mortality than the conventional surgery. cases report: we report two cases of coronary surgery with limited access. the first corresponds to a 72-year-old man with diabetes, hypertension, dyslipidemia, obesity, with myocardial damage and bypass surgery to anterior descendent coronary artery and first diagonal coronary artery with saphenous vein graft performed 13 years ago. due to unstable angina and positive test for myocardial ischemia, we performed bypass surgery of minimal access to the anterior descendent coronary artery and obtuse marginal coronary artery. the second case corresponds to a man with hypertension, diabetes, obesity, previous bypass surgery of two vessels performed 4 years ago, complicated with perioperative inferior myocardial infarction. due to unstable angina and positive test for myocardial viability, we performed a re-do coronary artery bypass graft surgery to the left anterior descending artery and first diagonal coronary arteries through a minimal access incision. in both the clinical evolution was satisfactory, they were discharged 7 days after surgery and remain asymptomatic at one year of follow-up. conclusion: the antero-lateral thoracoto-my off-pump coronary bypass surgery is an alternative indicated in high risk patient with coronary revascularization.