ABSTRACT
Introduced in the mid-1960s for single vessel, OPCAB surgery is currendy applicable to multivessel disease.1'4 The advent of mechanical stabilizers has been, without any doubt, a giant leap in the evolution of this technique. Needless to say that 40 years of collective experience with the coronary artery grafting technique have contributed to settling the modern foundation of OPCAB surgery, allowing its use in a majority of patients.5 Moreover, aging of the surgical population and the more aggressive use of coronary angioplasty have increased the surgical challenge. Surgeons are tempted to reconsider less invasive surgical approaches to cope with these new rules. Over the last few years, several randomized trials have been performed and more than 12,000 cases from the Society of Thoracic Surgery database have been reported and published. Avoidance of cardiopulmonary bypass (CPB) is beneficial for several reasons but is indubitably more demanding technically.
