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Implementing a new technical process demands a complex preparation. In cardiac surgery this complex preparation is often reduced to visiting a surgeon who is familiar with a technique. The science of learning has identified that several steps are needed towards a successful implementation. The first step is the creation of a complete conceptual approach; this demands the deposit in writing of the actions and reactions of every involved party in this new approach. By definition a successful implementation starts with the creation of a group of involved individuals willing to collaborate towards a new goal. Then every teachable component, described in this concept, needs to be worked out in simulation training, from the smallest manual step to complete scenario training for complex situations. Finally, optimal organisational learning needs to have an existing database of the previous situation, a clear goal and objective and a new database where every new approach is restudied versus the previous one, using appropriate methods of corrections for variability. A complete implementation will always be more successful versus a partial one, due to the habit in partial implementation to return to the previous routines.

We should ban the OPCAB approach in CABG, just as we should ban jetliners and bicycles, or maybe not!