ABSTRACT
S ince its reintroduction in the late 1990s, OPCAB surgery has been adopted by the international community in a proportion fluctuating from 1% to 98%.1,2 This large variability clearly reflects an incredible disparity in acceptance of the procedure. Diegler and his team from Leipzig initially proposed a series of indications regarding the procedure.3 With time, others encouraged a more liberal use of off-pump surgery.4 Ultimately, it became apparent that the limiting factor remained the surgeons experience. The main indication for going off-pump is obviously to decrease the inherent morbidity related to the use of the car diopulmonary bypass (CPB) especially among patients with significant co-morbid factors. Other indications are clotting disturbance, a calcified ascending aorta, and minimization of blood transfusions. But down the road, the final decision depends on the coronary anatomy, the shape of the myocardium, and tolerance of the patients hemodynamics to surgical mobiliza tions and manipulations. Table 1 depicts the major and relative contraindications to OPCAB surgery that we have applied in our 7-year experience over 900 cases. The purpose of this chapter is to review the different surgical strategies that we have developed and adapted to optimize the OPCAB procedure and propose a “survival guide” to OPCAB surgery.
