Feasible pericardiotomy for off-pump coronary artery bypass

Pericardiotomy is the first essential step for the exposure of the coronary artery in off-pump coronary artery bypass (OPCAB) via a median sternotomy. After the dissection of the pericardium from the pleura, a longitudinal pericardiotomy from the apex to the aortic reflection was employed. The pericardiotomy was extended transversely to make a trapezoidal flap. By the traction of the left pericardium, anterior vessels were well exposed. For the closure, a trapezoidal pericardial flap was useful.