Different stabilizer concepts and exposure techniques for off-pump coronary artery bypass surgery

Abstract

Coronary artery revascularization on the beating heart without the use of cardiopulmonary bypass (CPB) involves a more technically challenging anastomosis. Stabilizers are a major tool in OPCAB procedures, reducing the cardiac surface motion during suturing of the anastomosis. Initial attempts with multiple stay sutures, vessel loops, slings, and pharmacological movement adaptation with adenosine or other pharmacological agents [10] were successful but left a significant number of anastomotic stenoses or bypass occlusions (10%). The major limitation of these techniques was the residual cardiac surface motion, which may hamper the meticulous construction of the distal anastomosis. Thus, different cardiac surface stabilizers were developed for local cardiac immobilization, which improved early angiographic results markedly [8]. To reduce cardiac movement sufficiently, three different stabilizer concepts are available: 1) pressure stabilizers, 2) suction stabilizers, and 3) the platform technique (Fig. 1). Despite growing enthusiasm, these techniques were used almost exclusively in patients with coronary artery disease limited to the left anterior descending (LAD) artery. Revascularization of other coronary territories remained elusive because of technical difficulties with hemodynamic instability in exposing the lateral and inferior wall of the heart.