Off-pump coronary artery bypass grafting is a technically demanding procedure that allows for avoidance of the deleterious consequences of cardiopulmonary bypass and can facilitate a no- or minimal-aortic manipulation procedure. To ensure the construction of a precise and reproducible off-pump coronary anastomosis, adjunctive tools have been developed that, when used correctly, can create a near motionless and bloodless field, mimicking conditions of anastomosis on an arrested heart. These include cardiac positioning and stabilization devices, occlusive tapes and intracoronary shunts, and misted blowers. The chapter also discusses the use of a proximal anastomosis device to mitigate the risk of stroke and a transit-time flow meter for confirmation of graft patency. It offers practical suggestions on the correct use of each device as well as common pitfalls to avoid.
Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting
