Experimental off-pump grafting of a circumflex branch via sternotomy using a suction device

Assessment of myocardial injury by troponin T in off‐pump coronary artery grafting and conventional coronary artery graft surgery

“…Early literature, showing improved outcomes with off‐pump coronary artery grafting (OPCAB) compared with traditional coronary artery bypass graft (CABG) techniques 4,6 was often biased by between‐group differences, such as lower mean graft numbers in the OPCAB cohorts. Increasing familiarity with the epicardial stabilization devices and return to median sternotomy for surgical exposure have facilitated access to lateral and inferior left ventricular (LV) wall, allowing complete myocardial revascularization to be achieved with beating heart surgery 10,11 . The recent report by Contini et al supports the benefits for OPCAB surgery in patients undergoing multiple vessel revascularization for up to 2 years postoperatively 12 …”

What can be learned from the postoperative angiographic result in off-pump coronary artery bypass surgery on the beating heart?

“…The arrested heart provides all options for complex and difficult revascularisation procedures of a high and reproducible quality [6]. A reduced operative morbidity by avoiding cardiopulmonary bypass may have a positive effect on the patients´ outcome [3,4,14,22], but the most important determinant for long-term success after coronary artery bypass grafting is the patency of the ITA-graft to the LAD [17,19]. To assess the quality of the anastomosis, valid tests are necessary.…”

Anesthesia for off-pump coronary artery bypass surgery

“…[105] Trendelenburg positioning to 20° head down appears to be an efficient technique to improve preload and increase cardiac output. [98,106,107] The use of inotropes and/or vasopressor like dopamine, epinephrine, or norepinephrine, associated with an adequate and cautious fluid management is helpful. [24,96] An α-adrenergic agent, such as phenylephrine, is indicated when mean arterial pressure (MAP) remains low due to reduction of peripheral resistances in order to avoid large fluid administration.…”