[Toward the safest and most accurate graft anastomosis in coronary artery bypass grafting: basic considerations and...

Surgery for revascularization of the myocardium continues to be an effective and lasting means of managing patients with multivessel coronary artery disease. Ultimately, the goal in the operating room is to provide patients with grafts that have the best long-term patency. A significant number of coronary bypass cases are now being performed without the use of cardiopulmonary bypass, while cardiopulmonary bypass is often preferred or required in a certain number of patients. In the coronary artery bypass surgery, the anastomosis of a graft either on the arrested or on the beating heart is the most important and crucial procedure. In this chapter, we discuss the basic principles of the anastomotic technique of the graft by providing some technical tips and pitfalls on the procedure. These may include the followings; the difference between on a beating heart and on an arrested heart, importance of the perpendicular placement of the needle, the way of holding a needle holder, the way to handle tweezers, keeping a steady posture, keeping eyes on the anastomosis, avoiding the intimal injury, keeping concentration and so on.