Surgical technique for off-pump coronary artery bypass grafting

Abstract

The first attempts for developing an extracorporeal circulation system are found at the beginning of the 20th century, performed by so-called heart and circulation physiologists, with the aim of gaining access to the interior of the heart. Even if coronary artery bypass grafting is performed on the surface of the heart and initial procedures were performed without the use of cardiopulmonary bypass [6], the spread of use of cardiopulmonary bypass in cardiac surgery has led cardiac surgeons to always use the heart lung machine, even in bypass procedures. The median sternotomy played an important role, as it gives excellent access to the great vessels and enables easy and safe cannulation for extracorporeal circulation. On the other hand, the use of the heart lung machine enabled easier access to all coronary vessels with stable hemodynamics, in addition to ideal immobilization of coronary arteries. The above presented concept consisting of median sternotomy plus cardiopulmonary bypass (CPB) has been used for the past four decades. Cardiac surgery was very convenient for cardiac surgeons, who did not have to think about the kind of surgical access nor about the use of CPB or not. In the mid 1990s new procedures were presented changing this concept [1-3, 5, 8, 9]. Coronary artery bypass grafting without the use of CPB was, however, used previously in developing countries due to commercial aspects.