Key result
Advances in stabilization and anastomotic control largely overcome prior hesitations with OPCAB.
Why the study?
Satisfactory results with off-pump CABG require accuracy in anastomosis and safe management of regionally ischemic myocardium, with challenges in performing well-aligned coronary arteriotomy and suture placement under beating heart conditions.
May facilitate off-pump CABG in experienced centers; leaves open need for randomized outcome trials.
The key issues for satisfactory results with off-pump coronary artery bypass grafting (CABG) are accuracy with the anastomosis and safe management of the regionally ischemic myocardium. The greatest challenges confronted during creation of the anastomosis under beating heart conditions include performance of a well-aligned coronary arteriotomy without injury to the vessel back wall, accurately placed toe and heel sutures, and prevention of injury to the fragile edge of the arterial conduit and native artery during suture placement. With the concerted focus and development over the last 2–3 years, substantial headway has been made in these areas. There are now formalized and reproducible techniques to ensure optimal presentation of the myocardium and graft artery, for local immobilization of the myocardium, and to control the anastomotic site. As a result of these developments, the previously held hesitations concerning beating heart CABG have been largely averted.
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Robinson et al. (1999) conducted a review in Coronary artery disease requiring CABG. Off-pump coronary artery bypass grafting (CABG) and myocardial stabilization techniques was evaluated. Recent developments in myocardial stabilization and anastomotic site control have largely averted previous hesitations concerning beating heart off-pump coronary artery bypass grafting.
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