Off pump long-onlay-patch angioplasty to the LAD using the left internal mammary artery

Surgical treatment for diffusely diseased coronary arteries has been considered to be a relative contraindication for off pump coronary artery bypass (OPCAB) grafting. We report a case of off pump long-onlay-bypass grafting using the left internal mammary artery. To our knowledge, the long-onlay-patch grafting with OPCAB technique has not been previously described. Two sets of Octopus-3 tissue stabilizers were placed longitudinally along the target coronary artery (Double-Octopus technique). This technique allowed us to performed surgical angioplasty and bypass grafting without cardiopulmonary bypass support. Patients with severe diffuse coronary lesions who are at high risk for cardiopulmonary bypass will benefit from this technique.