Off-pump coronary artery bypass surgery

For nearly 15 years, coronary bypass surgery is alternatively performed without a heart-lung machine (OPCAB). The technique of OPCAB surgery differs from conventional coronary bypass surgery by maintaining the hemodynamic condition stable despite numerous maneuvers that are necessary to expose the target vessels. For this, good interaction with the anesthesiologist is required. The anesthesiologist supports the surgeon by influencing the pre- and after load with fluids, drugs, or just by positioning of the operating table. General rules have to be taken in consideration, such as body core cooling, tachycardia, myocardial ischemia, cardiac low-output, and arrhythmias. Exposure of the target vessel can be enabled with special instruments and techniques. Intracoronary shunts avoid ischemia and ensure that even on the beating heart the same quality of revascularization compared to conventional CABG can be achieved. MIDCAB surgery describes a minimally invasive method for accessing the heart through the 4th or 5th intercostal space to create a single vessel internal thoracic artery anastomosis to the left descending artery. A number of trials confirm that even under the scenario of limited access, coronary bypass anastomoses can be performed on the beating heart with excellent short- and long-term results.