Lung Retraction for Exposure of Lateral Wall Vessels in Off-Pump Bypass Grafting

One of the major challenges in off-pump coronary artery bypass grafting (OPCAB) is ensuring adequate exposure of the lateral wall vessels. In most cases when the left pleura is opened during harvesting of the left internal thoracic artery , the lung frequently obscures the view. Reducing the tidal volume is practised by certain surgeons, which however in the presence of a single lumen tube affects both lungs and is best avoided in OPCAB. We describe a technique that allows adequate exposure of the circumflex artery and its branches without compromising the tidal volume.