Off-Pump Coronary Artery Bypass Grafting

Off-pump coronary artery bypass graft (OPCAB) constitutes a minority of surgical revascularization procedures performed world wide, but it remains an important tool in the surgical armamentarium. If surgeons can achieve a comparable quality of anastomosis and completeness of revascularization as an on-pump procedure, OPCAB has the potential to reduce in-hospital morbidity and mortality in select high-risk patients. In this review, we describe our operative technique for OPCAB including perioperative medical management, the use of intraoperative imaging to reduce the risk of stroke, the optimal use of adjuncts to achieve a near bloodless field to allow for the creation of a precise and reproducible anastomosis and specialized tools to confirm graft flow.