Techniques of exposure and stabilization in off-pump coronary artery bypass graft

Recent advances in techniques of coronary artery exposure and myocardial st abilization in off-pump myocardial revascularization have provided cardiac surgeons with a wide variety of new devices and techniques. Until recently, the main obstacle to performing complete myocardial revascularization with out using cardiopulmonary bypass (CPB) has been the technical difficulties of exposing and stabilizing coronary targets, especially those located on t he lateral and inferior wall of the heart. The extraordinary cardiac tolera nce to nonconstrictive anterior elevation and lateral displacement, however , has allowed the development of new strategies of coronary exposure. These advances, in combination with the development of new techniques of mechani cal myocardial stabilization, have impacted on the feasibility and safety w ith which coronary anastomoses on the beating heart can be constructed. The aim of this article is to describe the technical aspects involved in off-p ump coronary revascularization, focusing primarily on the most recent strat egies of cardiac elevation and coronary exposure, the various techniques of myocardial stabilization, and some of the technical details of constructin g distal anastomoses on the beating heart.