Off-pump myocardial revascularization

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Off-pump coronary artery bypass (OPCAB) surgery literature is extensive but lacks standardized techniques.
• Variability in OPCAB approaches impacts consistent clinical application and outcomes.

Purpose of the Study:

• To present a standardized, reproducible off-pump coronary artery bypass grafting (OPCAB) technique developed at KU Leuven.
• To demonstrate a method that avoids the need for cardiopulmonary bypass (CPB) conversion.

Main Methods:

• The described technique involves patient conditioning, bilateral internal mammary artery harvesting via sternotomy, and precise pericardial stitching for anterior heart exposure.
• A stepwise approach for lateral and inferior heart exposure utilizes a posterior pericardial sling and an apical suction device for stabilization and visualization.
• Coronary anastomoses are performed using routine shunting for anterior vessels and a strict no-touch technique for free grafts to in-situ arterial grafts.

Main Results:

• The described technique allows for straightforward and replicable OPCAB without conversion to CPB.
• The method facilitates exposure of anterior, lateral, and inferior coronary vessels for revascularization.
• Utilizes a no-touch technique for anastomosing free grafts to in-situ arterial grafts.

Conclusions:

• The standardized KU Leuven OPCAB technique is effective and reproducible.
• This approach offers a viable alternative to conventional CABG with cardiopulmonary bypass.
• The technique ensures consistent surgical outcomes through meticulous exposure and graft management.